COMPARATIVE EFFECTIVENESS OF SGLT2 INHIBITORS VERSUS RAAS BLOCKERS IN SLOWING CKD PROGRESSION AMONG PATIENTS WITH DIABETIC NEPHROPATHY: INSIGHTS FROM REAL WORLD DATA
Author(s)
Vikash Kumar Verma, MBA, PharmD1, Louis Brooks Jr, MS2, Marissa Seligman, PharmD3, Abhimanyu Roy, MBA4, Abhinav Nayyar, MBA, MBBS5, Ankitkumar Arora, MPharm6, Anuj Gupta, MSc7, Vishan Khatavkar, MBA8, Ankita Bhagat, MS9, Shikha Anand, Other8, Archana Arya, MBA10, Prateek Kumar, Other11, Atish Chhaburao Musle, MBA12, Ruchi Singhal, PhD13.
1Optum Lifesciences, Boston, MA, USA, 2Optum, Bloomsbury, NJ, USA, 3Optum, Winchester, MA, USA, 4Optum, Gurgaon, India, 5Optum Life Sciences, Gurugram, India, 6Optum Global Solutions, Gurgaon, India, 7Optum Lifesciences, Noida, India, 8Optum Lifesciences, Gurugram, India, 9Optum, Guragon, India, 10Optum Global Solutions, Haryana, India, 11Optum Global Solutions, Hyderabad, India, 12Optum, Gurugram, India, 13Optum Global Solution, Gurgaon, India.
1Optum Lifesciences, Boston, MA, USA, 2Optum, Bloomsbury, NJ, USA, 3Optum, Winchester, MA, USA, 4Optum, Gurgaon, India, 5Optum Life Sciences, Gurugram, India, 6Optum Global Solutions, Gurgaon, India, 7Optum Lifesciences, Noida, India, 8Optum Lifesciences, Gurugram, India, 9Optum, Guragon, India, 10Optum Global Solutions, Haryana, India, 11Optum Global Solutions, Hyderabad, India, 12Optum, Gurugram, India, 13Optum Global Solution, Gurgaon, India.
OBJECTIVES: SGLT2 inhibitors (SGLT2i) and RAAS blockers are foundational therapies for diabetic nephropathy, yet real-world evidence comparing their effectiveness in slowing CKD progression is limited. This study examined renal outcomes associated with these two classes among patients with diabetic nephropathy.
METHODS: A retrospective cohort analysis was conducted using the Optum® Market Clarity database (June 2018-June 2023). Adults (≥18 years) with diabetic nephropathy and CKD (ICD-10 codes) were included; exclusions were ESRD, CKD stage 5, dialysis at baseline, and type 1/gestational diabetes. The index date was the first prescription refill of SGLT2i (Cohort 1) or RAAS blockers (ACEi/ARBs; Cohort 2). Continuous enrollment for 12 months pre- and post-index and adherence (PDC ≥80%) were required. Cohorts were propensity score-matched (1:2) on demographics, comorbidity index, and antidiabetic medications. Kidney outcomes were assessed by changes in eGFR and UACR over 12 months, with CKD staging per KDIGO guidelines.
RESULTS: After applying criteria, 16,377 patients were included in Cohort 1 and 32,754 in Cohort 2. Post-matching, mean age ranged from 67.6±9.9 to 69.2±10.9 years; 45.3% were female. From baseline to follow-up (SGLT2i vs RAAS blockers), UACR improved in 15.8% vs 14.7%, remained stable in 72.8% vs 71.0%, and worsened in 11.2% vs 14.1%; eGFR improved in 14.5% vs 17.7%, remained stable in 58.9% vs 56.3%, and worsened in 26.5% vs 25.9% of patients. Progression from G4 to G5 was lower with SGLT2i (5%) than RAAS blockers (13.7%). Differences in eGFR (p=0.0003) and UACR (p=0.0312) were significant.
CONCLUSIONS: Both therapies stabilized kidney function, but SGLT2i demonstrated lower rates of severe progression, suggesting a potential advantage in preserving renal health. Future research should evaluate economic impact to guide value-based care.
METHODS: A retrospective cohort analysis was conducted using the Optum® Market Clarity database (June 2018-June 2023). Adults (≥18 years) with diabetic nephropathy and CKD (ICD-10 codes) were included; exclusions were ESRD, CKD stage 5, dialysis at baseline, and type 1/gestational diabetes. The index date was the first prescription refill of SGLT2i (Cohort 1) or RAAS blockers (ACEi/ARBs; Cohort 2). Continuous enrollment for 12 months pre- and post-index and adherence (PDC ≥80%) were required. Cohorts were propensity score-matched (1:2) on demographics, comorbidity index, and antidiabetic medications. Kidney outcomes were assessed by changes in eGFR and UACR over 12 months, with CKD staging per KDIGO guidelines.
RESULTS: After applying criteria, 16,377 patients were included in Cohort 1 and 32,754 in Cohort 2. Post-matching, mean age ranged from 67.6±9.9 to 69.2±10.9 years; 45.3% were female. From baseline to follow-up (SGLT2i vs RAAS blockers), UACR improved in 15.8% vs 14.7%, remained stable in 72.8% vs 71.0%, and worsened in 11.2% vs 14.1%; eGFR improved in 14.5% vs 17.7%, remained stable in 58.9% vs 56.3%, and worsened in 26.5% vs 25.9% of patients. Progression from G4 to G5 was lower with SGLT2i (5%) than RAAS blockers (13.7%). Differences in eGFR (p=0.0003) and UACR (p=0.0312) were significant.
CONCLUSIONS: Both therapies stabilized kidney function, but SGLT2i demonstrated lower rates of severe progression, suggesting a potential advantage in preserving renal health. Future research should evaluate economic impact to guide value-based care.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO38
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
SDC: Urinary/Kidney Disorders