Heterogeneous Treatment Effects on Cardiovascular Diseases With Dipeptidyl Peptidase‐4 Inhibitors Versus Sulfonylureas in Type 2 Diabetes Patients

Sep 26, 2020Clinical pharmacology and therapeutics

Different heart disease effects of DPP-4 inhibitors versus sulfonylureas in people with type 2 diabetes

AI simplified

GLP-1 Therapies on OpenScience ↗PubMed ↗DOI ↗

Abstract

19,853 propensity score-matched pairs of patients were analyzed for treatment effects of dipeptidyl peptidase-4 inhibitors vs. sulfonylureas on cardiovascular diseases and mortality.

Patients with a history of ischemic stroke or transient ischemic attack showed a significant reduction in the risk of composite cardiovascular diseases when using DPP-4 inhibitors compared to sulfonylureas (absolute risk difference -4.31%, hazard ratio 0.81).
Younger patients (under 69.3 years) without prior cardiovascular diseases also experienced reduced risks when treated with DPP-4 inhibitors (absolute risk difference -0.90%, hazard ratio 0.86).
DPP-4 inhibitors were associated with lower risks of three-point major adverse cardiovascular events in patients with prior ischemic stroke or transient ischemic attack (absolute risk difference -4.22%, hazard ratio 0.80).
Similar benefits were observed in younger patients without prior ischemic stroke or transient ischemic attack, with a reduced risk of three-point major adverse cardiovascular events (absolute risk difference -0.68%, hazard ratio 0.81).
Factors such as history of cardiovascular disease and age at treatment initiation may influence the effectiveness of DPP-4 inhibitors compared to sulfonylureas.

AI simplified

This study explored heterogeneous treatment effects (HTEs) of the real-world use of dipeptidyl peptidase-4 inhibitors (DPP-4is) vs. sulfonylureas (SUs) on cardiovascular diseases (CVDs) and mortality in patients with type 2 diabetes. Utilizing Taiwan's National Health Insurance Research Database, 19,853 propensity score-matched pairs of DPP-4i and SU stable users were identified. Classification and regression tree analyses and Cox models were applied to explore HTEs, according to various patient characteristics, on the composite CVDs, three-point major adverse cardiovascular event (MACE), and all-cause mortality. The absolute risk difference (ARD), hazard ratio (HR), and 95% confidence interval (CI) were estimated for comparing treatment effects. CVD history, ischemic stroke, or transient ischemic attack (IS/TIA) history, and age at treatment initiation were significant treatment effect modifiers. Patients with prior IS/TIA but without any other prior CVDs benefited most in reduced risks of composite CVDs from using DPP-4i vs. SU (ARD -4.31%, 95% CI -7.48% to -1.14%, HR 0.81, 95% CI 0.69 ~ 0.95), followed by those without prior IS/TIA and CVDs and initiated with DPP-4i at age < 69.3 years (ARD -0.90%, 95% CI -1.47% to -0.32%, HR 0.86, 95% CI 0.77 ~ 0.97). Patients with prior IS/TIA benefited most in reduced risks of three-point MACE from using DPP-4i vs. SU (ARD -4.22%, 95% CV -6.66% to -1.78%, HR 0.80, 95% CI 0.69 ~ 0.93), followed by those without prior IS/TIA and initiated with DPP-4i at age < 69.3 years (ARD -0.68%, 95% CI -1.08% to -0.29%, HR 0.81, 95% CI 0.70 ~ 0.93). Consideration of CVD and IS/TIA histories and age could facilitate individualized diabetes management of using DPP-4i vs. SU. Future studies are warranted given the hypothesis-generating nature in this exploratory research.

Full Text

Full text is available at the source.

View full text (PDF) ↗View full text (XML) ↗View full text ↗

Heterogeneous Treatment Effects on Cardiovascular Diseases With Dipeptidyl Peptidase‐4 Inhibitors Versus Sulfonylureas in Type 2 Diabetes Patients

Abstract

Full Text

You found one interesting study. We’ll send the next 7.

what lands in your inbox each week:

Recent issues from the glp-1 therapies brief

Abstract

Full Text

Related papers

You found one interesting study. We’ll send the next 7.

what lands in your inbox each week:

Recent issues from the glp-1 therapies brief