Emerging data suggest that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) improve kidney outcomes for people with type 2 diabetes (T2D). Direct comparisons of the kidney and cardiovascular effectiveness of GLP-1 RA with sodium-glucose cotransporter 2 inhibitors (SGLT2i), a first-line therapy for this population, are needed. The authors compared kidney and cardiovascular outcomes for new users of SGLT2i and GLP-1 RAs with T2D. Using propensity score overlap weighting, we analyzed electronic health record data from 20 U.S. health systems contributing to PCORnet between 2015 and 2020. The primary kidney outcome was a composite of sustained 40% estimated glomerular filtration rate (eGFR) decline, incident end-stage kidney disease, or all-cause mortality over 2 years or until censoring. In addition, we examined cardiovascular and safety outcomes. The weighted study cohort included 35,004 SGLT2i and 47,268 GLP-1 RA initiators. Over a median of 1.2 years, the primary outcome did not differ between treatments (HR: 0.91; 95% CI: 0.81-1.02), although SGLT2i were associated with a lower risk of 40% eGFR decline (HR: 0.77; 95% CI: 0.65-0.91). Risks of mortality (HR: 1.08; 95% CI: 0.92-1.27), a composite of stroke, myocardial infarction, or death (HR: 1.03; 95% CI: 0.93-1.14), and heart failure hospitalization (HR: 0.95; 95% CI: 0.80-1.13) did not differ. Genital mycotic infections were more common for SGLT2i initiators, but other safety outcomes did not differ. The results were similar regardless of chronic kidney disease status. SGLT2i and GLP-1 RAs led to similar kidney and cardiovascular outcomes in people with T2D, though SGLT2i initiation was associated with a lower risk of 40% eGFR decline. (Evaluating Comparative Effectiveness of Empagliflozin in Type 2 Diabetes Population With and Without Chronic Kidney Disease; )

中文翻译：

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SGLT2 抑制剂与 GLP-1 受体激动剂在 2 型糖尿病中的肾脏和心血管疗效


新数据表明，胰高血糖素样肽 1 受体激动剂 (GLP-1 RA) 可改善 2 型糖尿病 (T2D) 患者的肾脏结局。需要直接比较 GLP-1 RA 与钠-葡萄糖协同转运蛋白 2 抑制剂 (SGLT2i)（针对该人群的一线治疗）的肾脏和心血管功效。作者比较了 SGLT2i 和 GLP-1 RA 新使用者与 T2D 的肾脏和心血管结局。使用倾向评分重叠加权，我们分析了 2015 年至 2020 年间为 PCORnet 贡献的 20 个美国卫生系统的电子健康记录数据。主要肾脏结果是估计肾小球滤过率 (eGFR) 持续下降 40%、终末期肾脏事件的综合结果2 年内或直至审查之前的疾病或全因死亡率。此外，我们还检查了心血管和安全结果。加权研究队列包括 35,004 名 SGLT2i 和 47,268 名 GLP-1 RA 起始药物。在中位 1.2 年的时间内，尽管 SGLT2i 与 40% eGFR 下降的较低风险相关（HR：0.77；95% CI：0.81-1.02），但治疗之间的主要结局没有差异（HR：0.91；95% CI：0.81-1.02） ：0.65-0.91）。死亡风险（HR：1.08；95% CI：0.92-1.27）、中风、心肌梗死或死亡（HR：1.03；95% CI：0.93-1.14）和心力衰竭住院（HR：0.95；95% CI：0.93-1.14）的复合风险。 95% CI：0.80-1.13）没有差异。 SGLT2i 起始剂的生殖器真菌感染更为常见，但其他安全性结果没有差异。无论慢性肾脏疾病状态如何，结果都是相似的。 SGLT2i 和 GLP-1 RA 在 T2D 患者中导致相似的肾脏和心血管结局，尽管 SGLT2i 启动与 eGFR 下降 40% 的风险较低相关。（评估恩格列净对患有和不患有慢性肾脏病的 2 型糖尿病人群的疗效比较；）