Journal Article

No Differences in Kidney Function Decline Between People With Type 2 Diabetes Starting a Sodium-Glucose Cotransporter 2 Inhibitor or a Glucagon-like Peptide-1 Receptor Agonist: A Real-world Retrospective Comparative Observational Study

Buzzetti, Raffaella, Amendolara, Rocco, Pieralice, Silvia, Bodini, Sara, Coraggio, Lucia, Risi, Renata, D'Onofrio, Luca, Maddaloni, Ernesto, Mignogna, Carmen, Salducci, Mauro

2024

Overview

•No head-to-head RCT has been conducted comparing GLP1RA and SGLT2i renal benefits.•This is a real-world study comparing eGFR decline in people on GLP1RA or SGLT2i.•A similar eGFR decline was observed between study groups over 36 months.•GLP1RA and SGLT2i lead to equal weight loss, with very similar changes in BMI.•Different side effects leading to equal rates of drug discontinuation were reported. Diabetic nephropathy represents the leading cause of end-stage kidney disease in developed countries. Cardiovascular outcome trials have found that in participants who received a glucagon-like peptide-1 receptor agonist (GLP1RA) and a sodium-glucose cotransporter 2 inhibitor (SGLT2i), the risk of incidence and progression of diabetic nephropathy in type 2 diabetes mellitus was reduced. The aim of this study was to compare the decline in estimated glomerular filtration rate (eGFR) among people taking a GLP1RA with that among people taking an SGLT2i in a real-world setting. Data for 478 patients with type 2 diabetes mellitus who initiated therapy with a GLP1RA (n = 254) or an SGLT2i (n = 224) between January 1, 2018 and December 31, 2021 were extracted. The primary outcome was any reduction ≥30% in eGFR after the start of therapy. Weight loss and drug discontinuation were also assessed. Over a median follow-up of 24 months, an eGFR reduction ≥30% occurred in 34 of 254 patients (13.4%) starting a GLP1RA and in 26 of 223 patients (11.6%) starting an SGLT2i (hazard ratio = 0.89; 95% CI, 0.54–1.49; P = 0.67). Median eGFR change over the whole follow-up was similar between groups (SGLT2i: median, –2 mL/min/1.73 m2; 25th, 75th percentile, –13, 8 mL/min/1.73 m2; GLP1RA: median, 0 mL/min/1.73 m2; 25th, 75th percentile, –10, 7 mL/min/1.73 m2; P = 0.54). No worsening of kidney function was observed, even when considering the ratio eGFR mean. The value of eGFR at baseline indicated a statistically significant indirect correlation with the observed absolute value of eGFR change over the follow-up (ρ = –0.36; P < 0.001). The difference in eGFR changes over time observed by eGFR categories was statistically significant (P = 0.0001) in both treatment groups. No significant differences in weight loss and drug discontinuations were observed between groups. Although acting on different molecular mechanisms, both GLP1RA and SGLT2i might have similar effects on eGFR decline in diabetes, as suggested by the results of the present study conducted in a real-world setting. (Clin Ther. 2024;46:XXX–XXX) © 2024 Elsevier HS Journals, Inc.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Aged / Agonists / Antihypertensives / Body mass index / Chronic kidney disease / Clinical medicine / Clinical trials / Creatinine / Diabetes / Diabetes mellitus / Diabetes mellitus (non-insulin dependent) / Diabetes Mellitus, Type 2 - complications / Diabetes Mellitus, Type 2 - drug therapy / Diabetes Mellitus, Type 2 - physiopathology / Diabetic Nephropathies - drug therapy / Diabetic Nephropathies - physiopathology / Diabetic nephropathy / Diabetic neuropathy / End-stage renal disease / Enzymes / Epidermal growth factor receptors / Ethics / Fasting / Female / Glomerular filtration rate / Glomerular Filtration Rate - drug effects / GLP-1 receptor agonists / GLP1RA / Glucagon / Glucagon-like peptide 1 / Glucagon-Like Peptide-1 Receptor - agonists / Glucagon-like peptide-1 receptor agonist / Glucose / Glycemic index / Humans / Hypoglycemic Agents - therapeutic use / Insulin / Internal Medicine / Kidney - drug effects / Kidney - physiopathology / Kidney diseases / Male / Middle Aged / Molecular modelling / Nephropathy / Nephroprotective action / Observational studies / Patients / Peptides / Retrospective Studies / SGLT2i / Sodium-glucose cotransporter / Sodium-glucose cotransporter 2 inhibitor / Sodium-Glucose Transporter 2 Inhibitors - adverse effects / Sodium-Glucose Transporter 2 Inhibitors - therapeutic use / Software / Statistical analysis / Urine