Semaglutide users had a 54% lower risk of stroke compared to those using DPP-4 inhibitors.
Semaglutide users experienced a 36% reduced risk of myocardial infarction compared to DPP-4i users.
The composite risk of stroke and myocardial infarction was 41% lower in semaglutide users.
Patients using semaglutide had fewer hospitalizations and outpatient visits related to .
Total medical costs were lower for semaglutide users compared to those on DPP-4 inhibitors.
Findings from two separate analyses using different health databases were generally consistent.
Simplified
INTRODUCTION: Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) have demonstrated cardiovascular benefits in trials involving high-risk patients with type 2 diabetes (T2D), while (DPP-4is) have not. However, DPP-4is are still commonly prescribed in patients with T2D and (ASCVD). This study compared time to occurrence of cardiovascular events, health care resource utilization (HCRU), and medical costs in patients with T2D and ASCVD who initiated once-weekly semaglutide vs a DPP-4i.
METHODS: Two separate observational cohort analyses were conducted using Optum's de-identified ClinformaticsData Mart Database (CDM) and Komodo Healthcare Map™ (January 1, 2018 to September 30, 2022). Patients had T2D and ASCVD and received semaglutide or a DPP-4i. Baseline characteristics were balanced using inverse probability of treatment weighting. ®
RESULTS: After weighting, the CDM analysis included 14,461 semaglutide users and 38,630 DPP-4i users and the Komodo Healthcare Map analysis included 48,303 semaglutide users and 109,179 DPP-4i users. In CDM, semaglutide users had significantly decreased risk of stroke (hazard ratio [HR], 0.54), myocardial infarction (HR 0.64), and their composite (HR 0.59) vs DPP-4is. Semaglutide users also had fewer ASCVD-related and all-cause hospitalizations and outpatient visits and lower ASCVD-related and all-cause hospitalization and total medical costs. Results from Komodo Health were generally consistent with those from CDM.
CONCLUSION: Semaglutide users had significantly reduced risk of cardiovascular outcomes, HCRU, and medical costs compared with DPP-4is. This corroborates results from prior studies of once-weekly GLP-1 RAs and reinforces the important role of semaglutide treatment for patients with T2D and ASCVD. Graphical abstract available for this article.
Key numbers
0.54
Lower Risk of Ischemic Stroke
for stroke in users vs. users.
0.64
Lower Risk of Myocardial Infarction
for myocardial infarction in users vs. users.
26%
Reduced Hospitalization Costs
Percentage reduction in all-cause hospitalization costs for users vs. users.
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Declarations. Conflict of Interest: Silvio E. Inzucchi reports honorarium for consulting and/or clinical trial committee work from AstraZeneca, Boehringer Ingelheim, Novo Nordisk, Merck, Pfizer, and Bayer. He has given lectures sponsored by AstraZeneca and Boehringer Ingelheim. Xi Tan, Yuanjie Liang, Larisa Yedigarova, and Lin Xie are employed by Novo Nordisk Inc. Adam de Havenon reports NIH/NINDS funding (K23NS105924, R01NS130189, UG3NS130228), has received investigator-initiated clinical research funding from the AAN, has received consultant fees from Integra and Novo Nordisk, has received royalty fees from UpToDate, and has equity in Titin KM and Certus. Ethical Approval: As this study involved retrospectively collected de-identified data, which was analyzed without further interaction with the human subjects, it was deemed to be exempt from institutional review board review.
