Kidney Week

Abstract: TH-PO1056

Comparative Effectiveness of Semaglutide, Liraglutide, and Dulaglutide for All-Cause Mortality in Type 2 Diabetes (T2D) with and without CKD: An Emulated Clinical Trial Observational Study

Session Information

• CKD: Therapeutic Advances
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Sarwal, Amara, University of Utah Health, Salt Lake City, Utah, United States

Amara Sarwal, MD

• Wei, Guo, University of Utah Health, Salt Lake City, Utah, United States

Guo Wei, MS

• Hartsell, Sydney Elizabeth, University of Utah Health, Salt Lake City, Utah, United States

Sydney Elizabeth Hartsell, MD, MPH

• Singh, Ravinder, University of Utah Health, Salt Lake City, Utah, United States

Ravinder Singh, MS

• Nevers, Mckenna R., University of Utah Health, Salt Lake City, Utah, United States

Mckenna R. Nevers, MSc

• Katkam, Niharika, University of Utah Health, Salt Lake City, Utah, United States

Niharika Katkam, MSc

• Takyi, Augustine, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States

Augustine Takyi

• Chakravartula, Akhil Ramanujam, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States

Akhil Ramanujam Chakravartula, MD, MBBS

• Shen, Jincheng, University of Utah Health, Salt Lake City, Utah, United States

Jincheng Shen, MS, PhD

• Beddhu, Srinivasan, University of Utah Health, Salt Lake City, Utah, United States

Srinivasan Beddhu, MD

Background

Compared to placebo, semaglutide, liraglutide and dulaglutide reduced the risk of CV events and CV death. However, there is a paucity of data on comparative effectiveness of these agents versus each other. Therefore, we examined the comparive risk of all-cause mortality (ACM) of these agents in a national cohort of veterans with T2D.

Methods

We used the active comparator, new user study design to compare the effect of initiating on semaglutide, liraglutide or dulaglutide on ACM in veterans with T2D on metformin who initiated any one of these three between 01/01/2018 to 12/31/2021 (N=22145). Those with previous use of these agents were excluded. Administrative censor date was 03/31/2023. ACM data were obtained from VA CDW which is also updated with national vital statistics. Generalized propensity score based inverse probability weighting (IPW) was employed to balance baseline variables across the three classes. In IPW Cox models, the study drug classes were related to the risk of mortality in those without and with CKD (eGFR < 60).

Results

49.1% were initiated on semaglutide, 24.6% on liraglutide and 25.0% on dulaglutide. Mean age was 64 ±11 years, 9% were female and 16.5% were Black. Mean was eGFR 81 ± 20. 17.2% had CKD. There were 1081 deaths/54727 years of follow-up in non-CKD and 489 deaths/10606 years in CKD subgroups. In non-CKD subgroup, both dulaglutide and semaglutide had higher hazard of ACM compared to liraglutide whereas dulaglutide and semaglutide had similar hazard (Figure). In CKD subgroup, hazard of ACM was similar across the three pairwise comparisons.

Conclusion

In the non-CKD subgroup, liraglutide had lower hazard of mortality compared to either dulaglutide or semaglutide. However, in the CKD subgroup, all three agents had similar risk of mortality.

Funding

• NIDDK Support