Objectives: To investigate changes in clinical characteristics of SGLT2i and GLP-1RA initiators in Denmark before/after landmark trials.

Materials and Methods: Compared first-time SGLT2i (25,070) and GLP-1RA (15,803) initiators to initiators of DPP-4i (without proven cardiovascular benefits), using linked population-based healthcare data to examine initiation incidence, medication patterns, and atherosclerotic cardiovascular disease (ASCVD) during 2014-2017.

Results: Nationwide incidence of SGLT2i initiators increased 3.6-fold (53/100,000 to 172/100,000 per year) vs. a 1.7-fold increase for GLP-1RA. DPP-4i initiation remained stable (Figure). From the end of 2015, SGLT2i was increasingly used as 2nd-line and GLP-1RA as 1st-line therapy. Among SGLT2i users, ASCVD increased slightly from 28% to 30%; age- and gender-adj. prevalence ratio (aPR) = 1.03 (95% CI:0.97-1.10). In contrast, among GLP-1RA initiators, ASCVD declined from 29% to 25% (aPR: 0.87 (95% CI:0.81-0.93)), and in DPP-4i initiators from 31% to 29% (aPR: 0.91 (95% CI:0.88-0.96)).

Conclusion: For SGLT2i, the EMPA-REG OUTCOME trial may have driven earlier adoption i.e., increased 2nd-line use, with minor increases in proportions with ASCVD. For GLP-1RA, we observed increased 1st-line use and decreasing ASCVD despite the LEADER trial, possibly due to anti-obesity treatment launch.

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Disclosure

J.S. Knudsen: None. L.M. Baggesen: None. M. Lajer: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. L. Nurkanovic: Employee; Self; Boehringer Ingelheim International GmbH. A.V. Ustyugova: Employee; Self; Boehringer Ingelheim International GmbH. H.T. Sôrensen: None. R.W. Thomsen: None.

Funding

Boehringer Ingelheim

© 2019 by the American Diabetes Association.
2019
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