COMPARATIVE EFFECTIVENESS OF GLP-1RA AND SGLT2I IN PATIENTS WITH DIABETIC KIDNEY DISEASE: A TARGET TRIAL EMULATION
Author(s)
KAI-CHENG CHANG, MS1, HUI-YU CHEN, MS2, Zi-Yang Peng, MS3, Huang-tz Ou, PhD3.
1PhD student, National Cheng Kung University, Taoyuan City, Taiwan, 2Department of Pharmacy, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, 3National Cheng Kung University, Tainan, Taiwan.
1PhD student, National Cheng Kung University, Taoyuan City, Taiwan, 2Department of Pharmacy, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan, 3National Cheng Kung University, Tainan, Taiwan.
OBJECTIVES: Diabetic kidney disease (DKD) represents a major global health burden. The novel glucose-lowering therapies, particularly glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i), have transformed the therapeutic landscape by demonstrating significant cardiorenal protective effects beyond glycemic control. However, comparative cardiovascular benefits with long-term follow-up remain limited among patients with DKD in real-world practices. We aimed to compare GLP-1RA with SGLT2i for a composite cardiovascular outcome.
METHODS: We conducted a target trial emulation using the largest electronic medical records database from seven hospitals in Taiwan. We included patients with type 2 diabetes and an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m². Patients newly receiving GLP-1RA or SGLT2i were included between January 2016 and December 2021. A composite major adverse cardiovascular event included myocardial infarction, stroke, cardiovascular death, and hospitalization for heart failure. We followed each patient until the occurrence of MACEs, loss of follow-up, or June 30, 2025, whichever came first. Inverse probability of treatment weighting (IPTW) by propensity score was applied to make baseline balance.
RESULTS: Among 9,951 eligible patients, 1,747 initiated GLP-1RA therapy, and 5,233 initiated SGLT2i therapy. After IPTW, baseline characteristics were comparable, with a mean age of 67.7 years and a mean eGFR level of 44.3 mL/min/1.73 m². With a mean follow-up of 4.2 years, SGLT2i (HR 0.85, 95% CI: 0.79-0.90) were associated with significantly lower risk of MACEs compared with GLP-1RA based on intention-to-treatment analysis. SGLT2i also shows better clinical benefits in individual MACE events. Sensitivity analyses, including propensity score matching and alternative definitions of MACE, yield consistent results.
CONCLUSIONS: Our findings indicate that SGLT2i provide substantial cardiovascular benefits in patients with DKD. Further study is warranted to confirm our results.
METHODS: We conducted a target trial emulation using the largest electronic medical records database from seven hospitals in Taiwan. We included patients with type 2 diabetes and an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m². Patients newly receiving GLP-1RA or SGLT2i were included between January 2016 and December 2021. A composite major adverse cardiovascular event included myocardial infarction, stroke, cardiovascular death, and hospitalization for heart failure. We followed each patient until the occurrence of MACEs, loss of follow-up, or June 30, 2025, whichever came first. Inverse probability of treatment weighting (IPTW) by propensity score was applied to make baseline balance.
RESULTS: Among 9,951 eligible patients, 1,747 initiated GLP-1RA therapy, and 5,233 initiated SGLT2i therapy. After IPTW, baseline characteristics were comparable, with a mean age of 67.7 years and a mean eGFR level of 44.3 mL/min/1.73 m². With a mean follow-up of 4.2 years, SGLT2i (HR 0.85, 95% CI: 0.79-0.90) were associated with significantly lower risk of MACEs compared with GLP-1RA based on intention-to-treatment analysis. SGLT2i also shows better clinical benefits in individual MACE events. Sensitivity analyses, including propensity score matching and alternative definitions of MACE, yield consistent results.
CONCLUSIONS: Our findings indicate that SGLT2i provide substantial cardiovascular benefits in patients with DKD. Further study is warranted to confirm our results.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
P8
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity), SDC: Urinary/Kidney Disorders