Introduction & Objective: In placebo-controlled trials, SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP1RA) improve kidney and cardiovascular outcomes. However, direct comparisons are lacking.
Methods: We analyzed EHR data from 20 US health systems that contribute to PCORnet. Using propensity scores and overlap weighting, we compared kidney and cardiovascular outcomes for initiators of SGLT2i and GLP1RA with type 2 diabetes between 2015-2020. The primary kidney outcome was a composite of 40% eGFR decline, incident ESKD, or all-cause mortality over 2 years or until censoring. We also examined cardiovascular and safety outcomes.
Results: Over a median of 1.2 years, risk for the primary outcome did not differ between the 35,004 SGLT2i and 47,268 GLP1RA initiators, though SGLT2i initiation was associated with lower risk of 40% eGFR decline (Table). Risks for mortality, cardiovascular outcomes, and most safety outcomes did not differ between groups, though genital mycotic infections were more common for SGLT2i initiators. Results were similar in patients with and without CKD.
Conclusion: In a large, real-world population with type 2 diabetes, risk for a composite kidney outcome, all-cause mortality, or cardiovascular outcomes was similar between initiators of SGLT2i and GLP1RA, though SGLT2i initiation was associated with a lower risk of 40% eGFR decline.
D. Edmonston: None. H. Mulder: None. E. Lydon: None. K. Chiswell: None. Z. Lampron: None. C.M. Shay: Employee; Boehringer-Ingelheim. K. Marsolo: Research Support; Boehringer-Ingelheim, Amgen Inc., Bayer Inc., Bristol-Myers Squibb Company, Novartis Pharmaceuticals Corporation, Seqirus, Genentech, Inc., Pfizer Inc. H.B. Bosworth: Research Support; BeBetter Therapeutics, Boehringer-Ingelheim, Improved Patient Outcomes, ESPERION Therapeutics, Inc., Novo Nordisk, Otsuka America Pharmaceutical, Inc., Sanofi, National Institutes of Health, Veterans Administration, elton john foundation. N. Pagidipati: Research Support; Alnylam Pharmaceuticals, Inc., Amgen Inc., Eli Lilly and Company. Consultant; ESPERION Therapeutics, Inc., AstraZeneca. Research Support; Boehringer-Ingelheim, Novartis AG, Novo Nordisk. Consultant; CRISPR Therapeutics. Research Support; Bayer Inc., Merck & Co., Inc. Consultant; Merck & Co., Inc., Boehringer-Ingelheim, Novo Nordisk, Bayer Inc., Novartis Pharmaceuticals Corporation. Other Relationship; Janssen Pharmaceuticals, Inc., Novartis Pharmaceuticals Corporation.
Boehringer Ingelheim
