Empagliflozin, Liraglutide Reduce Cardiovascular Mortality Risk

Investigators conducted a meta-analysis to compare the efficacy of SGLT2i, DPP-4i, and GLP-1 agonists for reducing cardiovascular outcomes.
Investigators conducted a meta-analysis to compare the efficacy of SGLT2i, DPP-4i, and GLP-1 agonists for reducing cardiovascular outcomes.

ORLANDO – Empagliflozin and liraglutide provide the greatest reduction in cardiovascular mortality, and sodium-glucose cotransporter-2 inhibitors (SGLT1i) may provide additional reductions in heart failure rates, according to results presented at the American Diabetes Association's 78th Scientific Sessions held in Orlando, Florida, June 22-26, 2018.

The study included 236 randomized controlled trials of >12 weeks' duration that included 176,310 participants with type 2 diabetes and compared drugs in the SGLT1i, dipeptyl peptidase-4 inhibitors (DPP-4i), or glucagon-like peptide-1 agonists (GLP-1a) classes with another included class or control.

The 236 studies included at total of 20 interventions: 6 DPP-4i, 7 GLP-1a, and 7 SGLT2i.

Compared with controls, empagliflozin and liraglutide reduced cardiovascular mortality (relative risk [RR] 0.63; 95% CI, 0.51-0.79; P <.001; and RR 0.79; 95% CI, 0.66-0.93, P =.006, respectively).

Empagliflozin treatment showed the most significant reduction in cardiovascular mortality, reducing fatal cardiovascular events more than 5 other drug types and control, including 2 DPP-4i, 2 GLP-1a, and 1 SGLT2i.

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Compared with control, both empagliflozin and canagliflozin reduced heart failure events compared with control (RR 0.66; 95% CI: 0.51-0.86, and RR 0.70; 95% CI: 0.54-0.90, respectively). However, saxagliptin actually increased heart failure events (RR 1.23; 95% CI, 1.04-1.46).

No drug of any class had an effect on myocardial infarction or stroke rate.

Reference

Roddick AJ, Zheng S. Comparative cardiovascular efficacy of SGLT2 inhibitors, DPP-4 inhibitors, and GLP-1 agonists—a network meta-analysis. Presented at the American Diabetes Association 2018 conference; June 22-26, 2018; Orlando, FL. Poster 427.