Association of Premorbid GLP-1RA and SGLT-2i Prescription Alone and in Combination with COVID-19 Severity.

IF 3.8 3区 医学 Q2 Medicine
Diabetes Therapy Pub Date : 2024-05-01 Epub Date: 2024-03-27 DOI:10.1007/s13300-024-01562-1
Klara R Klein, Trine J Abrahamsen, Anna R Kahkoska, G Caleb Alexander, Christopher G Chute, Melissa Haendel, Stephanie S Hong, Hemalkumar Mehta, Richard Moffitt, Til Stürmer, Kajsa Kvist, John B Buse
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引用次数: 0

Abstract

Introduction: People with type 2 diabetes are at heightened risk for severe outcomes related to COVID-19 infection, including hospitalization, intensive care unit admission, and mortality. This study was designed to examine the impact of premorbid use of glucagon-like peptide-1 receptor agonist (GLP-1RA) monotherapy, sodium-glucose cotransporter-2 inhibitor (SGLT-2i) monotherapy, and concomitant GLP1-RA/SGLT-2i therapy on the severity of outcomes in individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Methods: Utilizing observational data from the National COVID Cohort Collaborative through September 2022, we compared outcomes in 78,806 individuals with a prescription of GLP-1RA and SGLT-2i versus a prescription of dipeptidyl peptidase 4 inhibitors (DPP-4i) within 24 months of a positive SARS-CoV-2 PCR test. We also compared concomitant GLP-1RA/SGLT-2i therapy to GLP-1RA and SGLT-2i monotherapy. The primary outcome was 60-day mortality, measured from the positive test date. Secondary outcomes included emergency room (ER) visits, hospitalization, and mechanical ventilation within 14 days. Using a super learner approach and accounting for baseline characteristics, associations were quantified with odds ratios (OR) estimated with targeted maximum likelihood estimation (TMLE).

Results: Use of GLP-1RA (OR 0.64, 95% confidence interval [CI] 0.56-0.72) and SGLT-2i (OR 0.62, 95% CI 0.57-0.68) were associated with lower odds of 60-day mortality compared to DPP-4i use. Additionally, the OR of ER visits and hospitalizations were similarly reduced with GLP1-RA and SGLT-2i use. Concomitant GLP-1RA/SGLT-2i use showed similar odds of 60-day mortality when compared to GLP-1RA or SGLT-2i use alone (OR 0.92, 95% CI 0.81-1.05 and OR 0.88, 95% CI 0.76-1.01, respectively). However, lower OR of all secondary outcomes were associated with concomitant GLP-1RA/SGLT-2i use when compared to SGLT-2i use alone.

Conclusion: Among adults who tested positive for SARS-CoV-2, premorbid use of either GLP-1RA or SGLT-2i is associated with lower odds of mortality compared to DPP-4i. Furthermore, concomitant use of GLP-1RA and SGLT-2i is linked to lower odds of other severe COVID-19 outcomes, including ER visits, hospitalizations, and mechanical ventilation, compared to SGLT-2i use alone. Graphical abstract available for this article.

Abstract Image

病前单独或联合使用 GLP-1RA 和 SGLT-2i 与 COVID-19 严重程度的关系。
简介:2 型糖尿病患者因 COVID-19 感染而导致严重后果的风险较高,包括住院、入住重症监护室和死亡。本研究旨在探讨病前使用胰高血糖素样肽-1受体激动剂(GLP-1RA)单药治疗、钠-葡萄糖共转运体-2抑制剂(SGLT-2i)单药治疗以及GLP1-RA/SGLT-2i联合治疗对严重急性呼吸系统综合征冠状病毒2(SARS-CoV-2)感染患者严重后果的影响:利用国家 COVID 队列协作组织截至 2022 年 9 月的观察数据,我们比较了 78806 名患者在 SARS-CoV-2 PCR 检测呈阳性后 24 个月内 GLP-1RA 和 SGLT-2i 处方与二肽基肽酶 4 抑制剂 (DPP-4i) 处方的治疗效果。我们还将 GLP-1RA/SGLT-2i 同时治疗与 GLP-1RA 和 SGLT-2i 单药治疗进行了比较。主要结果是自检测呈阳性之日起 60 天内的死亡率。次要结果包括急诊室 (ER) 就诊、住院和 14 天内的机械通气。采用超级学习者方法并考虑基线特征,用目标最大似然估计(TMLE)估算的几率比(OR)对相关性进行量化:与使用 DPP-4i 相比,使用 GLP-1RA(OR 0.64,95% 置信区间 [CI] 0.56-0.72)和 SGLT-2i(OR 0.62,95% CI 0.57-0.68)与较低的 60 天死亡率相关。此外,使用 GLP1-RA 和 SGLT-2i 也同样降低了急诊室就诊和住院的几率。与单独使用 GLP-1RA 或 SGLT-2i 相比,同时使用 GLP-1RA/SGLT-2i 的 60 天死亡率几率相似(OR 分别为 0.92,95% CI 0.81-1.05 和 OR 0.88,95% CI 0.76-1.01)。然而,与单独使用SGLT-2i相比,同时使用GLP-1RA/SGLT-2i会降低所有次要结果的OR值:结论:在SARS-CoV-2检测呈阳性的成年人中,与DPP-4i相比,病前使用GLP-1RA或SGLT-2i与较低的死亡几率相关。此外,与单独使用 SGLT-2i 相比,同时使用 GLP-1RA 和 SGLT-2i 可降低 COVID-19 其他严重后果的发生几率,包括急诊室就诊、住院和机械通气。本文有图表摘要。
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来源期刊
Diabetes Therapy
Diabetes Therapy Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
6.90
自引率
7.90%
发文量
130
审稿时长
6 weeks
期刊介绍: Diabetes Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all areas of diabetes. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Diabetes Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.
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