Renoprotective Effects of Combination Treatment with Sodium-glucose Cotransporter Inhibitors and GLP-1 Receptor Agonists in Patients with Type 2 Diabetes Mellitus According to Preceding Medication
DOI:
https://doi.org/10.51094/jxiv.425Keywords:
sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonist, renal outcome, combination treatment, preceding drugAbstract
Aims: Combination therapy with sodium-glucose cotransporter inhibitors (SGLT2is) and GLP-1 receptor agonists (GLP1Ras) is now of interest in clinical practice for type 2 diabetes mellitus (T2DM) management. The present study evaluated the effects of the preceding drug type on the renal outcome in clinical practice.
Methods: We retrospectively extracted T2DM patients who had received both SGLT2i and GLP1Ra treatment for at least 1 year at 18 medical facilities in Japan. A total of 331 patients in the GLP1Ra-preceding group and 312 patients in the SGLT2i-preceding group were ultimately analyzed. The multiple imputation method and the analysis using propensity score was performed for the comparison of the renal composite outcome.
Results: The incidences of the renal composite outcome in the SGLT2i- and GLP1Ra-preceding groups was 28% and 25%, respectively, with an odds ratio (OR) [95%CI] of 1.14 [0.75, 1.73] (P=0.54).Compared to the GLP1Ra-preceding group, the annual change in the eGFR as well as the change in the logarithmic value of the urine albumin-to-creatinine ratio of patients in the SGLT2i-precedig group were 0.3 mL/min/1.73 m2/year [-0.3,1.0, p=0.35], and 0.20 [-0.06, 0.47, p=0.14], respectively.
Conclusion: With combination therapy of SGLT2i and GLP1Ra, the preceding drug might not affect the renal outcome.
Conflicts of Interest Disclosure
The authors declare no conflicts of interest in association with the present study.Downloads *Displays the aggregated results up to the previous day.
References
Nissen SE, Wolski K. Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes. New England Journal of Medicine. 2007;356:2457-71.
Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015;373:2117-28.
Neal B, Perkovic V, Mahaffey KW, de Zeeuw D, Fulcher G, Erondu N, et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med. 2017;377:644-57.
Wiviott SD, Raz I, Bonaca MP, Mosenzon O, Kato ET, Cahn A, et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. New England Journal of Medicine. 2019;380:347-57.
Perkovic V, Jardine MJ, Neal B, Bompoint S, Heerspink HJL, Charytan DM, et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. New England Journal of Medicine. 2019;380:2295-306.
Heerspink HJL, Stefánsson BV, Correa-Rotter R, Chertow GM, Greene T, Hou F-F, et al. Dapagliflozin in Patients with Chronic Kidney Disease. New England Journal of Medicine. 2020;383:1436-46.
Group TE-KC. Empagliflozin in Patients with Chronic Kidney Disease. New England Journal of Medicine. 2022.
Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JFE, Nauck MA, et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. New England Journal of Medicine. 2016;375:311-22.
Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jódar E, Leiter LA, et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. New England Journal of Medicine. 2016;375:1834-44.
Hernandez AF, Green JB, Janmohamed S, D'Agostino RB, Granger CB, Jones NP, et al. Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial. The Lancet. 2018;392:1519-29.
Gerstein HC, Sattar N, Rosenstock J, Ramasundarahettige C, Pratley R, Lopes RD, et al. Cardiovascular and Renal Outcomes with Efpeglenatide in Type 2 Diabetes. N Engl J Med. 2021;385:896-907.
Gerstein HC, Colhoun HM, Dagenais GR, Diaz R, Lakshmanan M, Pais P, et al. Dulaglutide and renal outcomes in type 2 diabetes: an exploratory analysis of the REWIND randomised, placebo-controlled trial. Lancet. 2019;394:131-8.
Rossing P, Caramori ML, Chan JCN, Heerspink HJL, Hurst C, Khunti K, et al. Executive summary of the KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease: an update based on rapidly emerging new evidence. Kidney International. 2022;102:990-9.
Kobayashi K, Toyoda M, Hatori N, Sakai H, Furuki T, Sato K, et al. Comparison of the blood pressure management between sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists. Scientific Reports. 2022;12.
Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982-92.
Sumida K, Nadkarni GN, Grams ME, Sang Y, Ballew SH, Coresh J, et al. Conversion of Urine Protein-Creatinine Ratio or Urine Dipstick Protein to Urine Albumin-Creatinine Ratio for Use in Chronic Kidney Disease Screening and Prognosis : An Individual Participant-Based Meta-analysis. Ann Intern Med. 2020;173:426-35.
Kobayashi K, Toyoda M, Kimura M, Hatori N, Furuki T, Sakai H, et al. Renal effects of sodium glucose co-transporter 2 inhibitors in Japanese type 2 diabetes mellitus patients with home blood pressure monitoring. Clin Exp Hypertens. 2019;41:637-44.
Shimamoto K, Ando K, Fujita T, Hasebe N, Higaki J, Horiuchi M, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2014). Hypertens Res. 2014;37:253-390.
DB R. Multiple Imputation for Nonresponse in Surveys. John Wiley ＆ Sons. 1987.
Rubin DB, Schenker N. Multiple imputation in health-care databases: an overview and some applications. Stat Med. 1991;10:585-98.
Enders CK. Applied missing data analysis. 2010:New York.
Aloisio KM, Swanson SA, Micali N, Field A, Horton NJ. Analysis of partially observed clustered data using generalized estimating equations and multiple imputation. Stata J. 2014;14:863-83.
Hershberger SL, Fisher DG. A Note on Determining the Number of Imputations for Missing Data. Structural Equation Modeling: A Multidisciplinary Journal. 2003;10:648-50.
Furukawa K, Preston DL, Misumi M, Cullings HM. Handling incomplete smoking history data in survival analysis. Stat Methods Med Res. 2017;26:707-23.
Sterne JA, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. Bmj. 2009;338:b2393.
Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharmaceutical Statistics. 2011;10:150-61.
Husain M, Birkenfeld AL, Donsmark M, Dungan K, Eliaschewitz FG, Franco DR, et al. Oral Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. New England Journal of Medicine. 2019;381:841-51.
Defronzo RA. Combination therapy with GLP-1 receptor agonist and SGLT2 inhibitor. Diabetes, Obesity and Metabolism. 2017;19:1353-62.
Muskiet MHA, Tonneijck L, Smits MM, van Baar MJB, Kramer MHH, Hoorn EJ, et al. GLP-1 and the kidney: from physiology to pharmacology and outcomes in diabetes. Nat Rev Nephrol. 2017;13:605-28.
Muskiet MH, Tonneijck L, Smits MM, Kramer MH, Diamant M, Joles JA, et al. Acute renal haemodynamic effects of glucagon-like peptide-1 receptor agonist exenatide in healthy overweight men. Diabetes Obes Metab. 2016;18:178-85.
Rizzo M, Abate N, Chandalia M, Rizvi AA, Giglio RV, Nikolic D, et al. Liraglutide reduces oxidative stress and restores heme oxygenase-1 and ghrelin levels in patients with type 2 diabetes: a prospective pilot study. J Clin Endocrinol Metab. 2015;100:603-6.
Drucker DJ. The Cardiovascular Biology of Glucagon-like Peptide-1. Cell Metab. 2016;24:15-30.
Tanaka S, Sugiura Y, Saito H, Sugahara M, Higashijima Y, Yamaguchi J, et al. Sodium-glucose cotransporter 2 inhibition normalizes glucose metabolism and suppresses oxidative stress in the kidneys of diabetic mice. Kidney Int. 2018;94:912-25.
Heerspink HJL, Kosiborod M, Inzucchi SE, Cherney DZI. Renoprotective effects of sodium-glucose cotransporter-2 inhibitors. Kidney Int. 2018;94:26-39.
Cherney DZI, Perkins BA, Soleymanlou N, Maione M, Lai V, Lee A, et al. Renal Hemodynamic Effect of Sodium-Glucose Cotransporter 2 Inhibition in Patients With Type 1 Diabetes Mellitus. Circulation. 2014;129:587-97.
Mann JFE, Ørsted DD, Brown-Frandsen K, Marso SP, Poulter NR, Rasmussen S, et al. Liraglutide and Renal Outcomes in Type 2 Diabetes. New England Journal of Medicine. 2017;377:839-48.
Tuttle KR, Lakshmanan MC, Rayner B, Busch RS, Zimmermann AG, Woodward DB, et al. Dulaglutide versus insulin glargine in patients with type 2 diabetes and moderate-to-severe chronic kidney disease (AWARD-7): a multicentre, open-label, randomised trial. Lancet Diabetes Endocrinol. 2018;6:605-17.
Kristensen SL, Rørth R, Jhund PS, Docherty KF, Sattar N, Preiss D, et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. The Lancet Diabetes & Endocrinology. 2019;7:776-85.
Mosenzon O, Wiviott SD, Heerspink HJL, Dwyer JP, Cahn A, Goodrich EL, et al. The Effect of Dapagliflozin on Albuminuria in DECLARE-TIMI 58. Diabetes Care. 2021;44:1805-15.
Kawai Y, Uneda K, Yamada T, Kinguchi S, Kobayashi K, Azushima K, et al. Comparison of effects of SGLT-2 inhibitors and GLP-1 receptor agonists on cardiovascular and renal outcomes in type 2 diabetes mellitus patients with/without albuminuria: A systematic review and network meta-analysis. Diabetes Res Clin Pract. 2022;183:109146.
Van Bommel EJM, Muskiet MHA, Van Baar MJB, Tonneijck L, Smits MM, Emanuel AL, et al. The renal hemodynamic effects of the SGLT2 inhibitor dapagliflozin are caused by post-glomerular vasodilatation rather than pre-glomerular vasoconstriction in metformin-treated patients with type 2 diabetes in the randomized, double-blind RED trial. Kidney International. 2020;97:202-12.
Kobayashi K, Toyoda M, Hatori N, Sakai H, Furuki T, Chin K, et al. Comparison of renal outcomes between sodium glucose co-transporter 2 inhibitors and glucagon-like peptide 1 receptor agonists. Diabetes Res Clin Pract. 2022;185:109231.
Tsapas A, Karagiannis T, Kakotrichi P, Avgerinos I, Mantsiou C, Tousinas G, et al. Comparative efficacy of glucose‐lowering medications on body weight and blood pressure in patients with type 2 diabetes: A systematic review and network meta‐analysis. Diabetes, Obesity and Metabolism. 2021;23:2116-24.
Rodbard HW, Rosenstock J, Canani LH, Deerochanawong C, Gumprecht J, Lindberg SØ, et al. Oral Semaglutide Versus Empagliflozin in Patients With Type 2 Diabetes Uncontrolled on Metformin: The PIONEER 2 Trial. Diabetes Care. 2019;42:2272-81.
van Baar MJB, van Ruiten CC, Muskiet MHA, van Bloemendaal L, RG IJ, van Raalte DH. SGLT2 Inhibitors in Combination Therapy: From Mechanisms to Clinical Considerations in Type 2 Diabetes Management. Diabetes Care. 2018;41:1543-56.
Davies MJ, D’Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2018;41:2669-701.
Rossing P, Caramori ML, Chan JCN, Heerspink HJL, Hurst C, Khunti K, et al. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney International. 2022;102:S1-S127.
Lee DSU, Lee H. Adherence and persistence rates of major antidiabetic medications: a review. Diabetology & Metabolic Syndrome. 2022;14.
Malik M, Falkentoft A, Jensen J, Andersson C, Parveen SL, Koeber L, et al. Adherence and discontinuation of sglt2-inhibitors and glp1-r agonists in patients with type 2 diabetes with and without cardiovascular disease. European Heart Journal. 2022;43.
Shirabe S, Yamazaki K, Oishi M, Arai K, Yagi N, Sato M, et al. Changes in prescription patterns and doses of oral antidiabetic drugs in Japanese patients with type 2 diabetes (JDDM70). Journal of Diabetes Investigation. 2023;14:75-80.
Downloads
Posted
Submitted: 2023-06-24 14:39:30 UTC
Published: 2023-06-29 05:31:10 UTC
License
Copyright (c) 2023
Kazuo Kobayashi
Masao Toyoda
Atsuhito Tone
Daiji Kawanami
Daisuke Suzuki
Daisuke Tsuriya
Hideo Machimura
Hidetoshi Shimura
Hiroshi Takeda
Hisashi Yokomizo
Kei Takeshita
Keiichi Chin
Keizo Kanasaki
Masaaki Miyauchi
Masuo Saburi
Miwa Morita
Miwako Yomota
Moritsugu Kimura
Nobuo Hatori
Shinichi Nakajima
Shun Ito
Shunichiro Tsukamoto
Takashi Murata
Takaya Matsushita
Takayuki Furuki
Takuya Hahimoto
Tomoya Umezono
Yoshimi Muta
Yuichi Takashi
Kouichi Tamura
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
