Effect of combination treatment with glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors on incidence of cardiovascular and serious renal events: population based cohort study
Errata to this article were published (BMJ, 16 May 2024 ↗ · 5 Jun 2024 ↗)
Authors' conclusion
In this cohort study, the GLP-1 receptor agonist-SGLT-2 inhibitor combination was associated with a lower risk of major adverse cardiovascular events and serious renal events compared with either drug class alone.
Study context
- Population
- Patients with T2D, UK Clinical Practice Research Datalink linked to Hospital Episode Statistics and Office for National Statistics; cohorts assembled January 2013–December 2020, follow-up to end of March 2021two matched cohorts
- Exposure
- GLP-1 RA–SGLT2i combination vs either drug class alone
- Outcome
- MACE and serious renal events, separately
Methodological detailsprevalent new-user design, emulating a trial, matched 1:1 on background drug, duration of background drug and time conditional propensity score
- Prevalent new-user design
- Emulating a trial
- Matched 1:1 on background drug, duration of background drug and time conditional propensity score
Main finding
As reported in the abstract
MACE
Hazard ratio (95% CI)
SGLT-2 inhibitor-GLP-1 receptor agonist combinationvs GLP-1 receptor agonists30% lower risk with combination; GLP-1 RA background cohort
0.70(0.49–0.99)
GLP-1 receptor agonist-SGLT-2 inhibitor combinationvs SGLT-2 inhibitors29% lower risk with combination; SGLT2i background cohort
0.71(0.52–0.98)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR (CI) | |
|---|---|---|
| Serious renal eventsSGLT-2 inhibitor-GLP-1 receptor agonist combinationvs GLP-1 receptor agonists57% lower risk with combination; GLP-1 RA background cohort · co-primary outcome, analysed separately from MACE | 0.43 (0.23–0.80) | |
| Serious renal eventsGLP-1 receptor agonist-SGLT-2 inhibitor combinationvs SGLT-2 inhibitorsWide CI; SGLT2i background cohort · co-primary outcome, analysed separately from MACE | 0.67 (0.32–1.41) | |
| 0.20.5125Hazard ratio (log scale) |
Secondary outcomes: MI, ischaemic stroke, CV mortality, HF, all cause mortality
- Secondary outcomes generated similar results but with wider confidence intervals
Original publication
Effect of combination treatment with glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors on incidence of cardiovascular and serious renal events: population based cohort study. BMJ. Published 25 April 2024. doi:10.
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