Loading ...

TOPLINE:

Sodium-glucose cotransporter 2 (SGLT2) inhibitors may be a better adjunct treatment to reduce anemia risk than glucagon-like peptide 1 receptor agonists (GLP-1 RAs) for patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) stages I-III.

METHODOLOGY:

• Although anemia occurs in 20%-30% of patients with T2D and CKD, current guidelines do not offer specific recommendations for adjuvant therapy to prevent anemia.
• This retrospective cohort study, using the Chang Gung Research Database, Taiwan, compared the incidence of anemia in patients with T2D and CKD stages I-III who initiated treatment with either SGLT2 inhibitors or GLP-1 RAs.
• Overall, the study included 13,799 patients who started SGLT2 inhibitors (n = 12,331; mean age, 62.4 years; 61.2% men) or GLP-1 RAs (n = 1468; mean age, 61.5 years; 61.3% men) between January 1, 2016, and December 31, 2021, with follow-up until December 31, 2022.
• Patients initiating treatment with SGLT2 inhibitors received empagliflozin, dapagliflozin, canagliflozin, and ertugliflozin, whereas those starting treatment with GLP-1 RAs received lixisenatide, liraglutide, dulaglutide, and semaglutide.
• The primary outcome was a composite of anemia outcomes, including:
  • Incident anemia events
  • Initiation of anemia treatment

TAKEAWAY:

• During the median follow-up of 2.5 years, 2887 and 429 composite anemia outcomes were recorded in patients receiving SGLT2 inhibitors and GLP-1 RAs, respectively.
• The incidence rate of composite anemia outcomes was 19% lower in patients receiving SGLT2 inhibitors than in those receiving GLP-1 RAs (hazard ratio [HR], 0.81; 95% CI, 0.73-0.90), with similar outcomes observed for different individual SGLT2 inhibitors.
• Although SGLT2 inhibitors were linked to a lower incidence of anemia events (HR, 0.79; 95% CI, 0.71-0.87), they were not associated with a lower initiation of anemia treatment (HR, 0.99; 95% CI, 0.83-1.19).
• Hematologic parameters such as hemoglobin level, hematocrit level, and red blood cell count remained unchanged in the SLGT2 inhibitor group but decreased in the GLP-1 RA group.

IN PRACTICE:

The authors wrote, "one additional composite anemia outcome may be prevented among every 55 patients with T2D and CKD stages I-III who newly receive SGLT2 inhibitors for a 1-year treatment compared with GLP-1 RA use."

SOURCE:

The study was led by Jia-Chian Hu, School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan. It was published online in JAMA Network Open.

LIMITATIONS:

Residual confounding can be a concern in cases where observational data are analyzed. The possibility of missing or losing follow-up data exists because the data were gathered from Taiwan's biggest healthcare system. There is also a potential for misclassification of outcomes due to unverified anemia diagnosis codes.

DISCLOSURES:

This study did not report any funding sources. The authors declared no conflicts of interest.