Lower Risk of CV Events and Death Associated with Initiation of SGLT2 vs. DPP-4 Inhibitors—Analysis from the CVD-REAL 2 Study
Authors: KOHSAKA SHUN , LAM CAROLYN S. , KIM DAE JUNG , KARASIK AVRAHAM , TANGRI NAVDEEP , GOH SU-YEN , THURESSON MARCUS , CHEN HUNGTA , SURMONT FILIP , HAMMAR NIKLAS , FENICI PETER , KOSIBOROD MIKHAIL ,   CVD-REAL INVESTIGATORS AND STUDY GROUP
Published: June 2018

DPP-4 inhibitors and SGLT2 inhibitors are widely used in T2D. Clinical trials demonstrated lower risk of CV events with SGLT2i, and a neutral effect on CV events with DPP-4i. However, large comparative studies are lacking. We compared the risk of death, hospitalization for heart failure (HHF), MI and stroke in patients starting the SGLT2i dapagliflozin (DAPA) vs. any DPP-4i, using real world data from S. Korea, Japan, Israel, and Canada. Patients initiating DAPA or DPP-4i were identified via national registries, claims, and medical records. Propensity scores for SGLT2i initiation were developed in each country, with 1:1 matching. Hazard ratios were assessed by country and pooled using weighted meta-analysis, with an intent-to-treat approach. In total, 128,066 patients were included (mean age 55 years, 46% women, 25% with history of CVD). Post-match, baseline characteristics were balanced across matched groups. Initiation of DAPA vs. DPP-4i was associated with significantly lower risk of death, HHF, MI and stroke (Figure 1). In a large cohort of T2D patients seen in clinical practice across 4 countries, 75% without established CVD, initiation of DAPA was associated with lower risk of CV events (including stroke) and death compared with DPP-4i.

Disclosure
S. Kohsaka: Research Support; Self; Bayer Yakuhin, Ltd.. Speaker's Bureau; Self; Bayer Yakuhin, Ltd.. Research Support; Self; Daiichi Sankyo Company, Limited. Speaker's Bureau; Self; Bristol-Myers Squibb Company. C.S. Lam: Research Support; Self; Boston Scientific Corporation, Bayer AG, Thermofisher, Medtronic, Vifor Pharma. Consultant; Self; Bayer AG, Novartis AG, AstraZeneca, Janssen Research & Development, Menarini Group, Abbott, Roche Diagnostics Corporation, Boehringer Ingelheim GmbH, Merck & Co., Inc.. D. Kim: None. A. Karasik: Stock/Shareholder; Self; Novo Nordisk A/S. Research Support; Self; Novo Nordisk A/S. Advisory Panel; Self; Novo Nordisk A/S, AstraZeneca. Research Support; Self; AstraZeneca. Consultant; Self; Boehringer Ingelheim GmbH. Advisory Panel; Self; Merck & Co., Inc., GlucoMe. N. Tangri: Research Support; Self; AstraZeneca. Advisory Panel; Self; AstraZeneca, Otsuka Holdings Co., Ltd. S. Goh: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim GmbH, Amgen Inc., Novo Nordisk A/S, Sanofi-Aventis, Servier. M. Thuresson: Consultant; Self; AstraZeneca. H. Chen: Employee; Self; AstraZeneca. F. Surmont: Employee; Self; AstraZeneca. N. Hammar: Employee; Self; AstraZeneca. Stock/Shareholder; Self; AstraZeneca. P. Fenici: Employee; Self; AstraZeneca. M. Kosiborod: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Amgen Inc., Sanofi, Boehringer Ingelheim GmbH, GlaxoSmithKline plc., Glytec Systems, Merck & Co., Inc., Novo Nordisk A/S, Janssen Pharmaceuticals, Inc., ZS Pharma, Inc., Intarcia Therapeutics, Inc., Novartis AG. Research Support; Self; AstraZeneca, Boehringer Ingelheim GmbH.