不同慢性肾病（CKD）分期的 2 型糖尿病患者在利拉鲁肽和度拉鲁肽之间的心血管预后。

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice Pub Date : 2025-03-01 DOI:10.1016/j.eprac.2024.11.016

Yu-Xuan Cai MD , Feng-Hsuan Liu MD , Jui-Hung Sun MD , Chia-Hung Lin MD, PhD

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引用次数: 0

摘要

目的：本研究旨在评价两种胰高血糖素样肽-1受体激动剂（GLP-1 RAs）利拉鲁肽和杜拉鲁肽在T2DM合并不同阶段CKD患者中的有效性和安全性。除了分析MACE作为主要结局外，还测量了肾功能恶化、肾脏疾病和其他与药物相关的安全事件，如尿路感染、胰腺炎、截肢和癌症。研究设计和方法：本回顾性分析包括2011年至2019年来自长庚研究数据库（CGRD）的362,842例T2DM患者，确定2,830例GLP-1 RA使用者。应用排除标准后，纳入1572例患者（945例利拉鲁肽组，627例杜拉鲁肽组）。主要终点是CKD分期的MACE发生率。结果：945例患者使用利拉鲁肽，627例患者使用杜拉鲁肽。本研究发现两种药物在不同肾功能水平下MACE发生率无显著差异。然而，在使用利拉鲁肽的患者中，随着肾功能恶化，MACE发生率显著增加，从eGFR为60-89 ml/min/1.73 m2时的风险比1.401 （95% CI 0.663-2.958）增加到eGFR为2时的风险比4.078 (95% CI 1.111-14.971, p=0.0079)，而在使用利拉鲁肽的患者中没有观察到这一趋势（p = 0.1906）。结论：利拉鲁肽和杜拉鲁肽对T2DM患者都是有效的GLP-1 RAs，但它们对心血管结局的影响因利拉鲁肽使用者CKD分期而异。相比之下，dulaglutide没有观察到这种趋势，这表明dulaglutide在更晚期的CKD阶段可能有更大的心血管益处。

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The Cardiovascular Outcomes Between Liraglutide and Dulaglutide Among Different Chronic Kidney Disease Stages in Patients With Type 2 Diabetes

Objective

This study aimed to evaluate the effectiveness and safety of 2 glucagon-like peptide-1 receptor agonists (GLP-1 RAs) liraglutide and dulaglutide, in patients with type 2 diabetes mellitus (T2DM) at various stages of chronic kidney disease (CKD). In addition to analyzing Major Adverse Cardiovascular Events (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 between 2011 and 2019, identifying 2830 GLP-1 RAs users. After applying exclusion criteria, 1572 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 2 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 = .0079) at an eGFR of <15 ml/min/1.73 m², a trend not observed in dulaglutide users (P = .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.

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来源期刊

Endocrine Practice ENDOCRINOLOGY & METABOLISM-

CiteScore

7.60

自引率

2.40%

发文量

546

审稿时长

41 days

期刊介绍： Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.