Glucagon-like Peptide-1 receptor agonists versus dipeptidyl-peptidase 4 inhibitors in advanced chronic kidney disease and end stage kidney disease: Real world effectiveness and persistence of therapy

Dec 7, 2024Journal of diabetes and its complications

Effectiveness and treatment continuation of GLP-1 receptor agonists versus DPP-4 inhibitors in advanced and end-stage kidney disease

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Abstract

A total of 236 eligible patients were identified, with 149 in the GLP-1 receptor agonist group and 87 in the DPP-4 inhibitor group.

Patients treated with GLP-1 receptor agonists experienced an average weight loss of -9.6% over 36 months, compared to -2.4% in the DPP-4 inhibitor group.
The estimated treatment difference in weight loss between GLP-1 receptor agonists and DPP-4 inhibitors was -7.1 percentage-points, with a p-value of less than 0.001.
Glycemic control, measured as change in HbA1c, improved significantly more in the GLP-1 receptor agonist group (-1.0%) compared to the DPP-4 inhibitor group (0.2%).
The estimated treatment difference in HbA1c change was -1.2 percentage-points, with a p-value of 0.04.
Long treatment persistence was observed in patients using GLP-1 receptor agonists in a real-world setting.

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BACKGROUND: Atherosclerotic cardiovascular disease is the leading cause of death in people with type 2 diabetes (T2D) and chronic kidney disease (CKD) or end-stage kidney disease (ESKD). Glucagon-Like Peptide-1 receptor agonists (GLP-1RA) reduce cardiovascular events, improve glycemic control, promote weight loss, and slow progression of nephropathy. Despite these benefits and professional society treatment guidelines recommendations, GLP-1RAs remain under-utilized in people with advanced CKD and ESKD due to tolerability and safety concerns.

METHODS: We conducted a retrospective cohort study comparing clinical outcomes and medication use details after initiating GLP-1RA or dipeptidyl-peptidase 4 inhibitor (DPP-4i) in people with T2D and advanced CKD or ESKD. Eligible patients were identified via electronic health record query with extraction of baseline demographics, vital signs, and laboratory values. A manual chart review was undertaken to confirm eligibility, medication use, and extract a detailed account of all side effects.

RESULTS: A total of 236 eligible patients (149 in the GLP-1RA group and 87 in the DPP-4i group) were identified. The average duration of treatment was 1036 (±909.9) and 1109 (±1090.9) days for GLP-1RA and DPP-4i, respectively. The average percentage weight loss from baseline to 36 months of treatment in the GLP-1RA group was -9.6 % (95 % CI, -11.3 to -7.8) versus -2.4 % (95 % CI, -5.4 to 0.5) in the DPP-4i group (estimated treatment difference (ETD) -7.1 (95 % CI, -10.6 to -3.7) percentage-points, p < 0.001). The change in HbA1c from baseline to 36 months of treatment was significantly greater in the GLP-1RA (-1.0 %) compared with the DPP-4i group (0.2 %) (ETD -1.2 (95 % CI, -2.1 to -0.3) percentage-points, p = 0.04).

CONCLUSION: In patients with T2D and advanced CKD or ESKD, treatment with GLP-1RAs in a real-world setting had long treatment persistence, and compared to DPP-4is, was associated with greater weight loss and glycemic improvement.

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Glucagon-like Peptide-1 receptor agonists versus dipeptidyl-peptidase 4 inhibitors in advanced chronic kidney disease and end stage kidney disease: Real world effectiveness and persistence of therapy

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