The cardiovascular outcomes between liraglutide and dulaglutide among different chronic kidney disease (CKD) stages in patients with type 2 diabetes.

Abstract

Objective: This study aimed to evaluate the effectiveness and safety of two glucagon-like peptide-1 receptor agonists (GLP-1 RAs), liraglutide and dulaglutide, in patients with T2DM at various stages of CKD. In addition to analyzing MACE as the primary outcome, kidney function deterioration, renal disease, and other drug-related safety events, such as urinary tract infections, pancreatitis, amputations, and cancers were measured.

Research design and methods: This retrospective analysis included 362,842 T2DM patients from the Chang Gung Research Database (CGRD) between 2011 and 2019, identifying 2,830 GLP-1 RA users. After applying exclusion criteria, 1,572 patients (945 on liraglutide, 627 on dulaglutide) were included. The primary outcome was MACE incidence across CKD stages.

Results: Of the included patients, 945 used liraglutide, and 627 used dulaglutide. This study found no significant difference in the incidence of MACE between the two drugs across varying kidney function levels. However, in patients using liraglutide, a significant increase in MACE incidence was observed with deteriorating kidney function, from an HR of 1.401 (95% CI 0.663-2.958) at an eGFR of 60-89 ml/min/1.73 m² to an HR of 4.078 (95% CI 1.111-14.971, p=0.0079) at an eGFR of <15 ml/min/1.73 m², a trend not observed in dulaglutide users (p = 0.1906).

Conclusion: Both liraglutide and dulaglutide are effective GLP-1 RAs in T2DM patients, but their impact on cardiovascular outcomes varies with CKD stage in liraglutide users. In contrast, this trend was not observed with dulaglutide, suggesting a potentially greater cardiovascular benefit of dulaglutide at more advanced CKD stages.