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Abstract: PO0954

Lower Cardiorenal Risk with SGLT2 Inhibitor vs. DPP4 Inhibitor in Type 2 Diabetes Patients Without Established Cardiovascular and Renal Diseases

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Birkeland, Kåre I., Oslo Universitetssykehus, Oslo, Norway
  • Bodegard, Johan, AstraZeneca PLC, Luton, United Kingdom
  • Banerjee, Amitava, University College London, London, London, United Kingdom
  • Kim, Dae Jung, Ajou University School of Medicine and Graduate School of Medicine, Suwon, Gyeonggi-do, Korea (the Republic of)
  • Eriksson, Jan W., Uppsala Universitet, Uppsala, Sweden
  • Thuresson, Marcus, Statisticon, Uppsala, Sweden
  • Okami, Suguru, AstraZeneca PLC, Luton, United Kingdom
  • Ha, Kyoung Hwa, Ajou University School of Medicine and Graduate School of Medicine, Suwon, Gyeonggi-do, Korea (the Republic of)
  • Kossack, Nils, Wissenschaftliches Institut fur Gesundheitsökonomie und Gesundheitssystemforschung, Berlin, Germany
  • Mamza, Jil Billy, AstraZeneca PLC, Luton, United Kingdom
  • Zhang, Ruiqi, AstraZeneca PLC, Luton, United Kingdom
  • Yajima, Toshitaka, AstraZeneca PLC, Luton, United Kingdom
  • Komuro, Issei, The University of Tokyo Graduate School of Medicine Faculty of Medicine, Tokyo, Tokyo, Japan
  • Kadowaki, Takashi, Toranomon Byoin, Minato-ku, Tokyo, Japan
Background

Cardiorenal disease, defined by chronic kidney disease (CKD) or heart failure (HF), is a frequent disease manifestation associated with serious risks in T2D patients. We compared new use of sodium-glucose cotransporter-2 inhibitor (SGLT2i) vs. dipeptidyl peptidase 4 inhibitor (DPP4i) and the risk of cardiorenal disease in T2D patients without history of established cardiovascular and renal disease, defined as CVRD-free.

Methods

In this observational cohort study, patients were identified in health care databases in England, Germany, Japan, Norway, Sweden, and South Korea between the years 2012 and 2018. New users of SGLT2i were propensity score matched 1:1 with users of DPP4i. Unadjusted Cox regressions were used to estimate hazard ratios (HRs) for outcomes; cardiorenal disease, HF, CKD, stroke, myocardial infarction (MI) cardiovascular (CV) - and all-cause death (ACD).

Results

Baseline characteristics were well balanced between the treatment groups (n=105,130 in each group) with mean follow up of 1.5 years and 315,015 patient-years. The distribution of follow-up time for SGLT2i and DPP4i types was, dominated by dapagliflozin (91.7%) and sitagliptin/linagliptin (55.0%). SGLT2i was associated with lower risk of cardiorenal disease, HF, CKD, CV- and all-cause death, HR (95% CI) 0.56 (0.42-0.74), 0.71 (0.59-0.86), 0.44 (0.28-0.69), 0.67 (0.59-0.77) and 0.61 (0.44-0.85) respectively. No differences for stroke (0.87 [0.69-1.09]) and MI (0.94 [0.80-1.11]).

Conclusion

In this large multinational observational study of CVRD-free T2D patients, the unique preventive effects of SGLT2is on cardiorenal disease reported from clinical trials are confirmed in a real-world setting.

Funding

  • Commercial Support – AstraZeneca