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Glucagon-like peptide-1 receptor agonists and atrial fibrillation: a systematic review and meta-analysis of randomised controlled trials.
J Endocrinol Invest. 2017 Nov; 40(11):1251-1258.JE

Abstract

BACKGROUND

The pharmacological stimulation of GLP-1 receptors is associated with an increase in heart rate. A pooled analysis of patient-level data from phase III trials with albiglutide revealed a significant increase in the risk of atrial fibrillation. Aim of the present meta-analysis is to summarize all available evidence on the effects of individual GLP-1 receptor agonists (RA), and of the whole class, on the incidence of atrial fibrillation.

METHODS

A Medline search for GLP-1 RA (exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, or semaglutide) was performed, collecting all randomized clinical trials with a duration ≥12 weeks, enrolling patients with type 2 diabetes and comparing a GLP-1 RA with placebo or any other non-GLP-1 RA drug.

RESULTS

Of the 113 trials fulfilling the inclusion criteria, 19 did not report information on atrial fibrillation, whereas 63 reported zero events in all treatment groups. In the remaining trials (enrolling 17,966 and 15,305 patients in GLP-1 RA and comparator arms, respectively, 55.3% women, with a mean age of 57.0 ± 3.8 years), treatment with GLP-1 RA was not associated with a significant increase in the incidence of atrial fibrillation [Mantel-Haenszel OR (95% CI) 0.87 (0.71-1.05), p = 0.15].

CONCLUSIONS

In conclusion, available data suggest that GLP-1 RA is not associated with atrial fibrillation, with the only possible exception of albiglutide. Newly onset atrial fibrillation deserves to be investigated as an event of special interest in future trials with GLP-1 RA.

Authors+Show Affiliations

Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy. matteo.monami@unifi.it.Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy.Diabetology Unit, Ospedale San Donato Arezzo, Arezzo, Italy.Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy.Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.Diabetology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Via delle Oblate 4, 50141, Florence, Italy.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

28569363

Citation

Monami, M, et al. "Glucagon-like Peptide-1 Receptor Agonists and Atrial Fibrillation: a Systematic Review and Meta-analysis of Randomised Controlled Trials." Journal of Endocrinological Investigation, vol. 40, no. 11, 2017, pp. 1251-1258.
Monami M, Nreu B, Scatena A, et al. Glucagon-like peptide-1 receptor agonists and atrial fibrillation: a systematic review and meta-analysis of randomised controlled trials. J Endocrinol Invest. 2017;40(11):1251-1258.
Monami, M., Nreu, B., Scatena, A., Giannini, S., Andreozzi, F., Sesti, G., & Mannucci, E. (2017). Glucagon-like peptide-1 receptor agonists and atrial fibrillation: a systematic review and meta-analysis of randomised controlled trials. Journal of Endocrinological Investigation, 40(11), 1251-1258. https://doi.org/10.1007/s40618-017-0698-7
Monami M, et al. Glucagon-like Peptide-1 Receptor Agonists and Atrial Fibrillation: a Systematic Review and Meta-analysis of Randomised Controlled Trials. J Endocrinol Invest. 2017;40(11):1251-1258. PubMed PMID: 28569363.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Glucagon-like peptide-1 receptor agonists and atrial fibrillation: a systematic review and meta-analysis of randomised controlled trials. AU - Monami,M, AU - Nreu,B, AU - Scatena,A, AU - Giannini,S, AU - Andreozzi,F, AU - Sesti,G, AU - Mannucci,E, Y1 - 2017/05/31/ PY - 2017/04/27/received PY - 2017/05/24/accepted PY - 2017/6/2/pubmed PY - 2018/6/28/medline PY - 2017/6/2/entrez KW - Atrial fibrillation KW - GLP-1 receptor agonists KW - Meta-analysis SP - 1251 EP - 1258 JF - Journal of endocrinological investigation JO - J. Endocrinol. Invest. VL - 40 IS - 11 N2 - BACKGROUND: The pharmacological stimulation of GLP-1 receptors is associated with an increase in heart rate. A pooled analysis of patient-level data from phase III trials with albiglutide revealed a significant increase in the risk of atrial fibrillation. Aim of the present meta-analysis is to summarize all available evidence on the effects of individual GLP-1 receptor agonists (RA), and of the whole class, on the incidence of atrial fibrillation. METHODS: A Medline search for GLP-1 RA (exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, or semaglutide) was performed, collecting all randomized clinical trials with a duration ≥12 weeks, enrolling patients with type 2 diabetes and comparing a GLP-1 RA with placebo or any other non-GLP-1 RA drug. RESULTS: Of the 113 trials fulfilling the inclusion criteria, 19 did not report information on atrial fibrillation, whereas 63 reported zero events in all treatment groups. In the remaining trials (enrolling 17,966 and 15,305 patients in GLP-1 RA and comparator arms, respectively, 55.3% women, with a mean age of 57.0 ± 3.8 years), treatment with GLP-1 RA was not associated with a significant increase in the incidence of atrial fibrillation [Mantel-Haenszel OR (95% CI) 0.87 (0.71-1.05), p = 0.15]. CONCLUSIONS: In conclusion, available data suggest that GLP-1 RA is not associated with atrial fibrillation, with the only possible exception of albiglutide. Newly onset atrial fibrillation deserves to be investigated as an event of special interest in future trials with GLP-1 RA. SN - 1720-8386 UR - https://www.unboundmedicine.com/medline/citation/28569363/Glucagon_like_peptide_1_receptor_agonists_and_atrial_fibrillation:_a_systematic_review_and_meta_analysis_of_randomised_controlled_trials_ L2 - https://link.springer.com/article/10.1007/s40618-017-0698-7 DB - PRIME DP - Unbound Medicine ER -