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Observational Study
. 2023 Nov 20;22(1):319.
doi: 10.1186/s12933-023-02051-8.

Once-weekly glucagon-like peptide-1 receptor agonists vs dipeptidyl peptidase-4 inhibitors: cardiovascular effects in people with diabetes and cardiovascular disease

Xi Tan  1 , Yuanjie Liang  1 , Jigar R Rajpura  1 , Larisa Yedigarova  1 , Josh Noone  1 , Lin Xie  1 , Silvio Inzucchi  2 , Adam de Havenon  3
Affiliations
Observational Study

Once-weekly glucagon-like peptide-1 receptor agonists vs dipeptidyl peptidase-4 inhibitors: cardiovascular effects in people with diabetes and cardiovascular disease

Xi Tan et al. Cardiovasc Diabetol. .

Abstract

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which have proven cardiovascular benefits, are recommended in people with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD). However, there is limited real-world evidence comparing the effects of once-weekly (OW) GLP-1 RAs and dipeptidyl peptidase-4 inhibitors (DPP-4is). This observational cohort study (1/1/2017-9/30/2021) used data from the Optum Clinformatics® Data Mart to compare time to incident clinical cardiovascular outcomes, health care resource utilization (HCRU), and medical costs in new adult users of OW GLP-1 RAs and DPP-4is with T2D and ASCVD.

Methods: Time to occurrence of ischemic stroke, myocardial infarction (MI), or their composite and ASCVD-related and all-cause HCRU and medical costs were investigated. Baseline characteristics were balanced using inverse probability of treatment weighting. Survival analyses were conducted to compare risks during exposure.

Results: OW GLP-1 RA users (weighted N = 25,287) had 26%, 22%, and 24% lower risk of ischemic stroke, MI, and their composite, respectively, compared with DPP-4i users (weighted N = 39,684; all P < 0.01). Compared with DPP-4i users, OW GLP-1 RA users had 25% and 26% lower ASCVD-related and all-cause hospitalization costs, 19% and 23% lower ASCVD-related and all-cause medical costs, 23% and 27% fewer ASCVD-related and all-cause hospitalizations, 13% and 8% fewer ASCVD-related and all-cause outpatient visits, and 8% fewer all-cause ER visits (all P < 0.01).

Conclusions: In adults with T2D and ASCVD, OW GLP-1 RAs are associated with reduced stroke and MI risks and ASCVD-related and all-cause HCRU and costs vs DPP-4is.

Keywords: Atherosclerotic cardiovascular disease; Glucagon-like peptide-1 receptor agonists; Major adverse cardiovascular events; Myocardial infarction; Stroke; Type 2 diabetes.

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Conflict of interest statement

XT, YL, JRR, LY, JN, and LX are employed by Novo Nordisk Inc. LX has been employed by Pfizer within the last 3 years. SI reports honorarium for consulting and/or clinical trial committee work from AstraZeneca, Boehringer Ingelheim, Novo Nordisk, Merck, Pfizer, and Bayer. He has given lectures sponsored by AstraZeneca and Boehringer Ingelheim. AdH reports NIH/NINDS funding (K23NS105924, R01NS130189, UG3NS130228). AdH has received investigator-initiated clinical research funding from the AAN, has received consultant fees from Integra and Novo Nordisk, has received royalty fees from UpToDate, and has equity in Titin KM and Certus. The study findings have been presented at the American Diabetes Association 83rd Scientific Sessions 2023 and at the International Conference on Pharmacoepidemiology (ICPE) 2023.

Figures

Fig. 1
Fig. 1
Clinical outcomes in adults with T2D and ASCVD on OW GLP-1 RAs or DPP-4is. Weighted incidence rates, hazard ratios, and cumulative incidence curves of clinical outcomes comparing OW GLP-1 RAs with DPP-4is among adults with T2D and ASCVD. *Indicates statistical significance (P < 0.05). ASCVD atherosclerotic cardiovascular disease, DPP-4is, dipeptidyl peptidase-4 inhibitors, GLP-1 RAs glucagon-like peptide-1 receptor agonists, OW once-weekly, T2D type 2 diabetes
Fig. 2
Fig. 2
HCRU in adults with T2D and ASCVD on OW GLP-1 RAs or DPP-4is. Weighted descriptive statistics and rate ratios of HCRU comparing OW GLP-1 RAs with DPP-4is among adults with T2D and ASCVD. *Indicates statistical significance (P < 0.05). ASCVD atherosclerotic cardiovascular disease, DPP-4is dipeptidyl peptidase-4 inhibitors, ER emergency room, GLP-1 RAs glucagon-like peptide-1 receptor agonists, HCRU health care resource utilization, IP inpatient, OP outpatient, OW once-weekly, T2D type 2 diabetes
Fig. 3
Fig. 3
Medical costs in adults with T2D and ASCVD on OW GLP-1 RAs or DPP-4is. Weighted descriptive statistics and rate ratios of medical costs comparing OW GLP-1 RAs with DPP-4is among adults with T2D and ASCVD. *Indicates statistical significance (P < 0.05). ASCVD atherosclerotic cardiovascular disease, DPP-4is dipeptidyl peptidase-4 inhibitors, GLP-1 RAs glucagon-like peptide-1 receptor agonists, IP inpatient, OW once-weekly, T2D type 2 diabetes
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