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Use of Glucagon-Like Peptide 1 Receptor Agonists and Risk of Serious Renal Events: Scandinavian Cohort Study.
Diabetes Care. 2020 Jun; 43(6):1326-1335.DC

Abstract

OBJECTIVE

To assess the association between use of glucagon-like peptide 1 (GLP-1) receptor agonists and risk of serious renal events in routine clinical practice.

RESEARCH DESIGN AND METHODS

This was a cohort study using an active-comparator, new-user design and nationwide register data from Sweden, Denmark, and Norway during 2010-2016. The cohort included 38,731 new users of GLP-1 receptor agonists (liraglutide 92.5%, exenatide 6.2%, lixisenatide 0.7%, and dulaglutide 0.6%), matched 1:1 on age, sex, and propensity score to a new user of the active comparator, dipeptidyl peptidase 4 (DPP-4) inhibitors. The main outcome was serious renal events, a composite including renal replacement therapy, death from renal causes, and hospitalization for renal events. Secondary outcomes were the individual components of the main outcome. Hazard ratios (HRs) were estimated using Cox models and an intention-to-treat exposure definition. Mean (SD) follow-up time was 3.0 (1.7) years.

RESULTS

Mean (SD) age of the study population was 59 (10) years, and 18% had cardiovascular disease. A serious renal event occurred in 570 users of GLP-1 receptor agonists (incidence rate 4.8 events per 1,000 person-years) and in 722 users of DPP-4 inhibitors (6.3 events per 1,000 person-years, HR 0.76 [95% CI 0.68-0.85], absolute difference -1.5 events per 1,000 person-years [-2.1 to -0.9]). Use of GLP-1 receptor agonists was associated with a significantly lower risk of renal replacement therapy (HR 0.73 [0.62-0.87]) and hospitalization for renal events (HR 0.73 [0.65-0.83]) but not death from renal causes (HR 0.72 [0.48-1.10]). When we used an as-treated exposure definition in which patients were censored at treatment cessation or switch to the other study drug, the HR for the primary outcome was 0.60 (0.49-0.74).

CONCLUSIONS

In this large cohort of patients seen in routine clinical practice in three countries, use of GLP-1 receptor agonists, as compared with DPP-4 inhibitors, was associated with a reduced risk of serious renal events.

Authors+Show Affiliations

Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden. Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden. Swedish National Diabetes Register, Västra Götalandsregionen, Gothenburg, Sweden.Swedish National Diabetes Register, Västra Götalandsregionen, Gothenburg, Sweden. Health Metrics, Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden. Swedish National Diabetes Register, Västra Götalandsregionen, Gothenburg, Sweden.K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway. HUNT Research Center, Faculty of Medicine, Norwegian University of Science and Technology, Levanger, Norway.K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway. HUNT Research Center, Faculty of Medicine, Norwegian University of Science and Technology, Levanger, Norway.Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark. Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. Department of Medicine, Stanford University School of Medicine, Stanford, CA.Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden. Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden peter.ueda@ki.se.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32295809

Citation

Pasternak, Björn, et al. "Use of Glucagon-Like Peptide 1 Receptor Agonists and Risk of Serious Renal Events: Scandinavian Cohort Study." Diabetes Care, vol. 43, no. 6, 2020, pp. 1326-1335.
Pasternak B, Wintzell V, Eliasson B, et al. Use of Glucagon-Like Peptide 1 Receptor Agonists and Risk of Serious Renal Events: Scandinavian Cohort Study. Diabetes Care. 2020;43(6):1326-1335.
Pasternak, B., Wintzell, V., Eliasson, B., Svensson, A. M., Franzén, S., Gudbjörnsdottir, S., Hveem, K., Jonasson, C., Melbye, M., Svanström, H., & Ueda, P. (2020). Use of Glucagon-Like Peptide 1 Receptor Agonists and Risk of Serious Renal Events: Scandinavian Cohort Study. Diabetes Care, 43(6), 1326-1335. https://doi.org/10.2337/dc19-2088
Pasternak B, et al. Use of Glucagon-Like Peptide 1 Receptor Agonists and Risk of Serious Renal Events: Scandinavian Cohort Study. Diabetes Care. 2020;43(6):1326-1335. PubMed PMID: 32295809.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of Glucagon-Like Peptide 1 Receptor Agonists and Risk of Serious Renal Events: Scandinavian Cohort Study. AU - Pasternak,Björn, AU - Wintzell,Viktor, AU - Eliasson,Björn, AU - Svensson,Ann-Marie, AU - Franzén,Stefan, AU - Gudbjörnsdottir,Soffia, AU - Hveem,Kristian, AU - Jonasson,Christian, AU - Melbye,Mads, AU - Svanström,Henrik, AU - Ueda,Peter, Y1 - 2020/04/15/ PY - 2019/10/18/received PY - 2020/03/20/accepted PY - 2020/4/17/pubmed PY - 2020/4/17/medline PY - 2020/4/17/entrez SP - 1326 EP - 1335 JF - Diabetes care JO - Diabetes Care VL - 43 IS - 6 N2 - OBJECTIVE: To assess the association between use of glucagon-like peptide 1 (GLP-1) receptor agonists and risk of serious renal events in routine clinical practice. RESEARCH DESIGN AND METHODS: This was a cohort study using an active-comparator, new-user design and nationwide register data from Sweden, Denmark, and Norway during 2010-2016. The cohort included 38,731 new users of GLP-1 receptor agonists (liraglutide 92.5%, exenatide 6.2%, lixisenatide 0.7%, and dulaglutide 0.6%), matched 1:1 on age, sex, and propensity score to a new user of the active comparator, dipeptidyl peptidase 4 (DPP-4) inhibitors. The main outcome was serious renal events, a composite including renal replacement therapy, death from renal causes, and hospitalization for renal events. Secondary outcomes were the individual components of the main outcome. Hazard ratios (HRs) were estimated using Cox models and an intention-to-treat exposure definition. Mean (SD) follow-up time was 3.0 (1.7) years. RESULTS: Mean (SD) age of the study population was 59 (10) years, and 18% had cardiovascular disease. A serious renal event occurred in 570 users of GLP-1 receptor agonists (incidence rate 4.8 events per 1,000 person-years) and in 722 users of DPP-4 inhibitors (6.3 events per 1,000 person-years, HR 0.76 [95% CI 0.68-0.85], absolute difference -1.5 events per 1,000 person-years [-2.1 to -0.9]). Use of GLP-1 receptor agonists was associated with a significantly lower risk of renal replacement therapy (HR 0.73 [0.62-0.87]) and hospitalization for renal events (HR 0.73 [0.65-0.83]) but not death from renal causes (HR 0.72 [0.48-1.10]). When we used an as-treated exposure definition in which patients were censored at treatment cessation or switch to the other study drug, the HR for the primary outcome was 0.60 (0.49-0.74). CONCLUSIONS: In this large cohort of patients seen in routine clinical practice in three countries, use of GLP-1 receptor agonists, as compared with DPP-4 inhibitors, was associated with a reduced risk of serious renal events. SN - 1935-5548 UR - https://www.unboundmedicine.com/medline/citation/32295809/Use_of_Glucagon-Like_Peptide_1_Receptor_Agonists_and_Risk_of_Serious_Renal_Events:_Scandinavian_Cohort_Study L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=32295809 DB - PRIME DP - Unbound Medicine ER -
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