Changes in SGLT2i and GLP-1RA real-world initiator profiles following cardiovascular outcome trials: A Danish nationwide population-based study

• Jakob S. Knudsen
• Baggesen L.M.
• Lajer M.
• Nurkanovic L.
• Ustyugova A.
• Sørensen H.T.
• Thomsen R.W.

Abstract

Background. We investigated changes in clinical characteristics ofSGLT2i and GLP-1RA real-world initiators in Denmark before/after landmark cardiovascular outcome trials.

Methods. We compared first-time SGLT2i (25 070) and GLP-1RA (14671) initiators to initiators of DPP-4i (n=34 079), a class without proven cardiovascular benefits. We used linked population-based healthcare data to examine initiation incidence, medication patterns, and pre-existing atherosclerotic cardiovascular disease (ASCVD) during 2014-2017.

Results. Nationwide incidence of SGLT2i initiatorsincreased 3.6-fold (53/100000 to 172/100000 per year) vs. a 1.5-fold increase for GLP-1RA. DPP-4i initiation remained stable. From the end of 2015, SGLT2i was increasingly used as 2^nd line therapy, while medication patterns were much more stable for GLP-1RA. Among SGLT2i users, ASCVD increased slightly from 28% to 30%; age- and gender-adj. prevalence ratio (aPR) = 1.03 (95% CI: 0.97-1.10). In contrast, among GLP-1RA initiators, baseline ASCVD declined from 29 to 27% [aPR: 0.90 (95% CI:0.84-0.97)], and in DPP-4i initiators from 31% to 29% [aPR: 0.91 (95% CI: 0.88-0.96)].

Conclusions. Following the EMPA-REG OUTCOME trialin 2015, SGLT2i have become increasingly used as 2^nd line treatment in everyday clinical practice, with only minor increases in patient proportions with ASCVD. For GLP-1RA, we observed more stable therapy lines and slightly decreasing ASCVD in new users despite the LEADER trial.

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