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Comparative Study
. 2021 Jan;12(1):67-73.
doi: 10.1111/jdi.13321. Epub 2020 Jul 26.

Sodium-glucose cotransporter 2 inhibitors compared with other glucose-lowering drugs in Japan: Subanalyses of the CVD-REAL 2 Study

Shun Kohsaka  1 , Masayoshi Takeda  2 , Johan Bodegård  3 , Marcus Thuresson  4 , Mikhail Kosiborod  5 , Toshitaka Yajima  2 , Eric Wittbrodt  6 , Peter Fenici  7
Affiliations
Comparative Study

Sodium-glucose cotransporter 2 inhibitors compared with other glucose-lowering drugs in Japan: Subanalyses of the CVD-REAL 2 Study

Shun Kohsaka et al. J Diabetes Investig. 2021 Jan.

Abstract

There are limited data on cardiovascular efficacy and safety of type 2 diabetes therapies in Japan, where treatments are characterized by lower metformin use and higher dipeptidyl peptidase-4 inhibitor (DPP4i) use versus other countries. We investigated the cardiovascular outcomes in Japanese patients with type 2 diabetes initiating sodium-glucose cotransporter 2 inhibitors (SGLT2i) matched 1:1 to patients initiating other glucose-lowering drugs (33,890 patients/group) or DPP4i (9,876 patients/group). SGLT2i initiation was associated with lower risks (hazard ratio of in-hospital death [death] 0.56, 95% confidence interval [CI] 0.47-0.67; hospitalization for heart failure 0.75, 95% CI 0.64-0.89; composite of hospitalization for heart failure or death 0.65, 95% CI 0.58-0.74 and stroke 0.66, 95% CI 0.52-0.84 versus other glucose-lowering drugs and lower risks of death 0.52, 95% CI 0.36-0.73) and composite of hospitalization for heart failure or death (0.65, 95% CI 0.51-0.83) versus DPP4i. In conclusion, SGLT2i initiators had lower risks of cardiovascular events versus other glucose-lowering drug initiators and, uniquely, versus DPP4i initiators in Japanese real-world practice.

Keywords: Cardiovascular event; Sodium-glucose cotransporter 2; Type 2 diabetes.

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Conflict of interest statement

JB, M Takeda, TY, EW and PF are full‐time employees of AstraZeneca. M Thuresson is employed by Statisticon, for which AstraZeneca is a client. SK reports grants and/or personal fees from Bayer Yakuhin, Daiichi Sankyo, Bristol‐Myers Squibb, Pfizer and AstraZeneca, outside the submitted work. MK reports personal fees from AstraZeneca during the conduct of the study; and grants, personal fees and other support from AstraZeneca, Boehringer Ingelheim, Sanofi, Amgen, NovoNordisk, Merck (Diabetes), Eisai, Janssen, Bayer, GlaxoSmithKline, Glytec, Intarcia, Novartis, Applied Therapeutics, Amarin and Eli Lilly, outside the submitted work.

Figures

Figure 1
Figure 1
Patient disposition. DPP4i, dipeptidyl peptidase‐4 inhibitor; oGLD, other glucose‐lowering drug; PSM, propensity score matching; SGLT2i, sodium–glucose cotransporter 2 inhibitor.
Figure 2
Figure 2
Hazard ratios for the study outcomes in sodium–glucose cotransporter 2 inhibitor (SGLT2i) initiators versus other glucose‐lowering drug (oGLD) initiators in all patients and according to history of cardiovascular disease (CVD). See Figure S1 for the Kaplan–Meier plots showing the cumulative event rates for each event type. CI, confidence interval; HHF, hospitalization for heart failure; HR, hazard ratio; MI, myocardial infarction.
Figure 3
Figure 3
Hazard ratios for the study outcomes in sodium–glucose cotransporter 2 inhibitor (SGLT2i) initiators versus dipeptidyl peptidase‐4 inhibitor (DPP4i) initiators in all patients and according to history of cardiovascular disease (CVD). See Figure S2 for the Kaplan–Meier plots showing the cumulative event rates for each event type. CI, confidence interval; HHF, hospitalization for heart failure; HR, hazard ratio; MI, myocardial infarction.
See this image and copyright information in PMC

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