CV Risk With Common Diabetes Drugs Assessed in Recent Review

According to a recent review, empagliflozin, liraglutide, and semaglutide had beneficial effects on cardiovascular (CV) risk among patients with type 2 diabetes.

Over 25 trials are currently being conducted to determine the effects of antidiabetes drugs on CV risk after the US Food and Drug Administration issued guidance in 2008 mandating that all new antidiabetes drugs rule out excess CV risk.
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The current review included 7 of these studies with available results, 3 of which assessed the effects of dipeptidyl peptidase 4 inhibitors, 1 assessed the effects of sodium–glucose cotransporter 2 (SGLT2) inhibitor, and 3 assessed the effects of glucagon-like peptide 1 receptor agonists (GLP-1 RA).

All 7 studies showed noninferiority in the rate of major cardiovascular events (MACE) in patients taking antidiabetes agents when compared with placebo, however 3 showed possible CV benefits associated with an SGLT2 (empagliflozin) inhibitor and 2 GLP-1 RAs (liraglutide and semaglutide).

According to the authors’ findings, empagliflozin and liraglutide significantly reduced the risk of MACE, CV-associated mortality, and all-cause mortality when compared with placebo. Semaglutide was also found to significantly lower the rate of MACE but not CV or all-cause mortality when compared with placebo.

All of the trials showed that the effects of treatment on outcomes were out of proportion to the small differences in glycemic control levels, which suggested that the effects observed on CV risk were likely not related to difference in the glucose-lowering efficacy.

“Overall, the results of these trials yield a favorable benefit-risk balance for these therapies in mitigating CV risk in patients with type 2 diabetes,” the researchers concluded. “More research is needed to elucidate the underlying mechanisms and confirm whether the CV benefits are a class effect or whether the benefits persist in patients without established CV disease or are evident even in patients without diabetes.”

—Melissa Weiss

Reference:

Mitigating cardiovascular risk in type 2 diabetes with antidiabetes drugs: a review of principal cardiovascular outcome results of EMPA-REG OUTCOME, LEADER, and SUSTAIN-6 trials [published online June 21, 2017]. Diabetes Care. https://doi.org/10.2337/dc17-0291