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Abstract: PO0752

A Comparison of the Renal Composite Outcome Between Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide 1 Receptor Agonists in Japanese Diabetes Patients

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Kobayashi, Kazuo, Kanagawa-ken, Yokohama, Kanagawa, Japan
  • Hatori, Nobuo, Kanagawa-ken, Yokohama, Kanagawa, Japan
  • Toyoda, Masao, Tokai Daigaku, Isehara, Kanagawa, Japan
  • Tamura, Kouichi, Yokohama Shiritsu Daigaku Igakubu Daigakuin Igaku Kenkyuka, Yokohama, Kanagawa, Japan
Background

The renal outcome benefit in some large-scale clinical trials has been most pronounced for not only sodium-glucose co-transporter 2 inhibitors (SGLT2i), but also glucagon-like peptide 1 receptor agonists (GLP1Ra) in patients with type 2 diabetes mellitus (T2DM). However, there is not enough evidence of direct comparison between these drugs in clinical practice.

Methods

We retrospectively built two databases of T2DM patients who were visiting members of the Kanagawa Physicians Association. One database consisted of T2DM patients who were administered SGLT2i and the other of T2DM patients who were administered GLP1Ra for more than a year. We compared the renal composite outcome of 541 SGLT2i-treated patients without the concomitant use of GLP1Ra and 265 GLP1Ra-treated patients without the concomitant use of SGLT2i.
We have set the renal composite endpoint as the progression of the stage of albuminuria or the decrease of estimated glomerular filtration rate (eGFR) by ≥15% per year. For comparative analyses, we built the cohort model of patients treated with SGLT2i or GLP1Ra, using a propensity score–matching method with the following algorithm: 1:1 nearest neighbor match with a ±0.063 caliper and no replacement.

Results

The comparison of 134 propensity-matched patients in each group was performed. The median values of the age, body mass index, eGFR, ACR, and duration of treatment when both groups were combined were 64.0 years, 26.9, 71.1 mL/min/1.73 m2, 29.8 mg/gCr, and 36 months, respectively. The incidence of renal composite outcome was significantly lower in SGLT2i treated patients than in GLP1Ra treated patients (n = 15 [11%] and n = 27 [20%], respectively, p = 0.001 by McNemar’s test). The estimate hazard ratios and robust 95% confidence intervals (CI) for the renal composite outcome by the analysis of cox proportional hazards models were 0.69(95% CI, 0.53, 0.90; p = 0.006)in SGLT2i treated patients. There was a significant difference in the annual change in eGFR between the two groups: -1.8 ± 5.1 % in SGLT2i treated patients and -3.4 ± 7.0 % in GLP1Ra treated patients (p = 0.0049).

Conclusion

By this retrospective study, SGLT2i treatment had shown more preferable influence on the change of eGFR than GLP1Ra treatment in Japanese T2DM patients.