دورية أكاديمية
أعرض في EDS

SGLT-2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors and risk of hyperkalemia among people with type 2 diabetes in clinical practice: population based cohort study.

التفاصيل البيبلوغرافية
العنوان: SGLT-2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors and risk of hyperkalemia among people with type 2 diabetes in clinical practice: population based cohort study.
المؤلفون: Fu EL; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands., Wexler DJ; Diabetes Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.; Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA., Cromer SJ; Diabetes Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.; Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA., Bykov K; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA., Paik JM; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.; Division of Renal (Kidney) Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.; New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA., Patorno E; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
المصدر: BMJ (Clinical research ed.) [BMJ] 2024 Jun 26; Vol. 385, pp. e078483. Date of Electronic Publication: 2024 Jun 26.
نوع المنشور: Journal Article; Comparative Study
اللغة: English
بيانات الدورية: Publisher: British Medical Association Country of Publication: England NLM ID: 8900488 Publication Model: Electronic Cited Medium: Internet ISSN: 1756-1833 (Electronic) Linking ISSN: 09598138 NLM ISO Abbreviation: BMJ Subsets: MEDLINE
أسماء مطبوعة: Original Publication: London : British Medical Association
مواضيع طبية MeSH: Diabetes Mellitus, Type 2*/drug therapy , Diabetes Mellitus, Type 2*/complications , Hyperkalemia*/chemically induced , Hyperkalemia*/epidemiology , Sodium-Glucose Transporter 2 Inhibitors*/adverse effects , Sodium-Glucose Transporter 2 Inhibitors*/therapeutic use , Dipeptidyl-Peptidase IV Inhibitors*/therapeutic use , Dipeptidyl-Peptidase IV Inhibitors*/adverse effects , Glucagon-Like Peptide-1 Receptor*/agonists, Humans ; Male ; Female ; Aged ; Middle Aged ; United States/epidemiology ; Cohort Studies ; Hypoglycemic Agents/adverse effects ; Hypoglycemic Agents/therapeutic use ; Propensity Score ; Glucagon-Like Peptide-1 Receptor Agonists
مستخلص: Objectives: To evaluate the comparative effectiveness of sodium-glucose cotransporter-2 (SGLT-2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase-4 (DPP-4) inhibitors in preventing hyperkalemia in people with type 2 diabetes in routine clinical practice.
Design: Population based cohort study with active-comparator, new user design.
Setting: Claims data from Medicare and two large commercial insurance databases in the United States from April 2013 to April 2022.
Participants: 1:1 propensity score matched adults with type 2 diabetes newly starting SGLT-2 inhibitors versus DPP-4 inhibitors (n=778 908), GLP-1 receptor agonists versus DPP-4 inhibitors (n=729 820), and SGLT-2 inhibitors versus GLP-1 receptor agonists (n=873 460).
Main Outcome Measures: Hyperkalemia diagnosis in the inpatient or outpatient setting. Secondary outcomes were hyperkalemia defined as serum potassium levels ≥5.5 mmol/L and hyperkalemia diagnosis in the inpatient or emergency department setting.
Results: Starting SGLT-2 inhibitor treatment was associated with a lower rate of hyperkalemia than DPP-4 inhibitor treatment (hazard ratio 0.75, 95% confidence interval (CI) 0.73 to 0.78) and a slight reduction in rate compared with GLP-1 receptor agonists (0.92, 0.89 to 0.95). Use of GLP-1 receptor agonists was associated with a lower rate of hyperkalemia than DPP-4 inhibitors (0.79, 0.77 to 0.82). The three year absolute risk was 2.4% (95% CI 2.1% to 2.7%) lower for SGLT-2 inhibitors than DPP-4 inhibitors (4.6% v 7.0%), 1.8% (1.4% to 2.1%) lower for GLP-1 receptor agonists than DPP-4 inhibitors (5.7% v 7.5%), and 1.2% (0.9% to 1.5%) lower for SGLT-2 inhibitors than GLP-1 receptor agonists (4.7% v 6.0%). Findings were consistent for the secondary outcomes and among subgroups defined by age, sex, race, medical conditions, other drug use, and hemoglobin A1c levels on the relative scale. Benefits for SGLT-2 inhibitors and GLP-1 receptor agonists on the absolute scale were largest for those with heart failure, chronic kidney disease, or those using mineralocorticoid receptor antagonists. Compared with DPP-4 inhibitors, the lower rate of hyperkalemia was consistently observed across individual agents in the SGLT-2 inhibitor (canagliflozin, dapagliflozin, empagliflozin) and GLP-1 receptor agonist (dulaglutide, exenatide, liraglutide, semaglutide) classes.
Conclusions: In people with type 2 diabetes, SGLT-2 inhibitors and GLP-1 receptor agonists were associated with a lower risk of hyperkalemia than DPP-4 inhibitors in the overall population and across relevant subgroups. The consistency of associations among individual agents in the SGLT-2 inhibitor and GLP-1 receptor agonist classes suggests a class effect. These ancillary benefits of SGLT-2 inhibitors and GLP-1 receptor agonists further support their use in people with type 2 diabetes, especially in those at risk of hyperkalemia.
Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare the following: support from Brigham and Women’s Hospital, Harvard Medical School, the Netherlands Organization for Scientific Research, Patient-Centered Outcomes Research Institute, Food and Drug Administration, National Institutes of Health, National Institute on Aging, American Diabetes Association for the submitted work. EP is principal investigator of an investigator initiated grant to the Brigham and Women’s Hospital from Boehringer Ingelheim, not directly related to the topic of the submitted work; DJW reports serving on data monitoring committees for Novo Nordisk not related to the topic of this work; SJC reports serving on advisory boards for Alexion Pharmaceuticals and employment of a family member by a Johnson and Johnson company. No other potential conflicts of interest relevant to this article were reported.
(© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
References: J Biopharm Stat. 2020 Jul 3;30(4):734-751. (PMID: 32191555)
Kidney Int. 2022 Nov;102(5):990-999. (PMID: 36272755)
Kidney Int. 2020 Jan;97(1):42-61. (PMID: 31706619)
Diabetes Care. 2021 Aug 3;:. (PMID: 34344714)
J Clin Epidemiol. 2011 Jul;64(7):749-59. (PMID: 21208778)
Diabetes Care. 2022 Dec 1;45(12):2926-2934. (PMID: 36282149)
Diabetes Care. 2023 Jan 1;46(Suppl 1):S140-S157. (PMID: 36507650)
Kidney Int. 2024 Mar;105(3):618-628. (PMID: 38101515)
Kidney360. 2022 Aug 2;3(12):2019-2026. (PMID: 36591361)
J Gerontol A Biol Sci Med Sci. 2018 Jun 14;73(7):980-987. (PMID: 29244057)
J Am Heart Assoc. 2017 Jul 19;6(7):. (PMID: 28724651)
N Engl J Med. 2015 Jan 15;372(3):222-31. (PMID: 25415807)
Am J Physiol Renal Physiol. 2019 Feb 1;316(2):F231-F240. (PMID: 30353743)
Eur Heart J. 2021 Dec 21;42(48):4891-4901. (PMID: 34423370)
Eur Heart J. 2022 Aug 14;43(31):2984-2993. (PMID: 35687107)
N Engl J Med. 2016 Jul 28;375(4):323-34. (PMID: 27299675)
Hypertension. 2020 Apr;75(4):894-901. (PMID: 32114848)
Eur Heart J. 2018 May 1;39(17):1535-1542. (PMID: 29554312)
J Am Coll Cardiol. 2007 Nov 13;50(20):1959-66. (PMID: 17996561)
N Engl J Med. 2004 Aug 5;351(6):543-51. (PMID: 15295047)
Stat Med. 2009 Nov 10;28(25):3083-107. (PMID: 19757444)
Endocr Rev. 2021 Sep 28;42(5):658-690. (PMID: 33710268)
Nephrol Dial Transplant. 2019 Oct 1;34(10):1629-1635. (PMID: 30215791)
Clin J Am Soc Nephrol. 2023 Feb 24;:. (PMID: 36827225)
N Engl J Med. 2021 Nov 4;385(19):1737-1749. (PMID: 34554658)
Am J Epidemiol. 2010 Aug 1;172(3):334-43. (PMID: 20606039)
Clin Kidney J. 2021 Dec 02;15(4):727-737. (PMID: 35371465)
N Engl J Med. 2017 Aug 17;377(7):644-657. (PMID: 28605608)
Lancet Diabetes Endocrinol. 2019 Aug;7(8):606-617. (PMID: 31196815)
Diabetologia. 2016 Jul;59(7):1412-1421. (PMID: 27038451)
Circulation. 2022 May 10;145(19):1460-1470. (PMID: 35394821)
Cardiovasc Diabetol. 2022 Mar 23;21(1):47. (PMID: 35321742)
Clin J Am Soc Nephrol. 2015 Jun 5;10(6):1050-60. (PMID: 24721891)
Eur Heart J. 2022 Nov 1;43(41):4362-4373. (PMID: 35900838)
Am Heart J. 2022 Jan;243:177-186. (PMID: 34610282)
Kidney Int. 2023 Jan;103(1):30-33. (PMID: 36603981)
Stat Med. 2007 May 20;26(11):2389-430. (PMID: 17031868)
Curr Opin Nephrol Hypertens. 2023 May 1;32(3):290-296. (PMID: 36811640)
PLoS Med. 2008 Mar 11;5(3):e67. (PMID: 18336067)
N Engl J Med. 2004 Aug 5;351(6):585-92. (PMID: 15295051)
Eur J Heart Fail. 2021 Oct;23(10):1698-1707. (PMID: 34196082)
Diabetes Care. 2020 Nov;43(11):2859-2869. (PMID: 32938746)
Clin J Am Soc Nephrol. 2024 Mar 1;19(3):399-405. (PMID: 37639260)
Curr Epidemiol Rep. 2015 Dec;2(4):221-228. (PMID: 26954351)
Am J Kidney Dis. 2022 Aug;80(2):164-173.e1. (PMID: 35085685)
Eur Heart J. 2023 Jun 25;44(24):2216-2230. (PMID: 37259575)
Kidney Int. 2022 Feb;101(2):360-368. (PMID: 34826514)
Lancet Diabetes Endocrinol. 2021 Oct;9(10):653-662. (PMID: 34425083)
J Am Soc Nephrol. 2023 Aug 1;34(8):1305-1314. (PMID: 37131279)
Int J Cardiol. 2017 Oct 15;245:277-284. (PMID: 28735756)
J Am Soc Nephrol. 2022 Jan;33(1):225-237. (PMID: 34732509)
المشرفين على المادة: 0 (Sodium-Glucose Transporter 2 Inhibitors)
0 (Dipeptidyl-Peptidase IV Inhibitors)
0 (Glucagon-Like Peptide-1 Receptor)
0 (Hypoglycemic Agents)
0 (Glucagon-Like Peptide-1 Receptor Agonists)
تواريخ الأحداث: Date Created: 20240626 Date Completed: 20240626 Latest Revision: 20240702
رمز التحديث: 20240702
مُعرف محوري في PubMed: PMC11200155
DOI: 10.1136/bmj-2023-078483
PMID: 38925801
قاعدة البيانات: MEDLINE
الوصف
تدمد:1756-1833
DOI:10.1136/bmj-2023-078483