TOPLINE:
In patients with type 2 diabetes (T2D), the use of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) is associated with lower rates of hyperkalemia and sustained use of guideline-recommended renin-angiotensin system inhibitors (RASis) compared with the use of dipeptidyl peptidase-4 inhibitors (DPP-4is).
METHODOLOGY:
- Hyperkalemia is a common electrolyte complication in patients with T2D, particularly those with chronic kidney disease and heart failure; hyperkalemia or fear of it may limit the use of RASis such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs).
- Researchers evaluated the comparative effectiveness of GLP-1 RA vs DPP-4i use on hyperkalemia risk with an emulated observation trial design using a healthcare utilization cohort of all residents in Stockholm, Sweden, and data from linked national registries.
- The study included 33,280 patients with T2D (mean age, 63.7 years; 59.7% men) who were new users of any GLP-1 RA or DPP-4i between 2008 and 2021.
- The primary outcome was the incidence of hyperkalemia (potassium level, > 5.0 mEq/L), and the secondary outcome was the incidence of moderate to severe hyperkalemia (potassium level, > 5.5 mEq/L).
- In a secondary analysis, the persistence to RASi therapy was evaluated in a subgroup of 21,751 patients with T2D who were using RASis at the time of initiating GLP-1 RA or DPP-4i.
TAKEAWAY:
- Stopping or switching treatments was common. During a median follow-up of 3.9 months, 752 patients experienced at least one hyperkalemia event, with incidence rates of 21.0 per 1000 person-years for GLP-1 RA initiators and 39.0 for DPP-4i initiators.
- The use of GLP-1 RAs was associated with a 38% reduced risk for hyperkalemia (weighted hazard ratio [HR], 0.62; 95% CI, 0.50-0.76) and 48% reduced risk for moderate to severe hyperkalemia (weighted HR, 0.52; 95% CI, 0.28-0.84) compared with the use of DPP-4is.
- RASi discontinuation rates were lower in patients who initiated GLP-1 RAs, with an incidence rate of 146.2 per 1000 person-years compared with 170.2 for DPP-4i users (weighted HR, 0.89; 95% CI, 0.82-0.97).
- The 12-month absolute risks for hyperkalemia were 2.9% in the GLP-1 RA group and 4.6% in the DPP-4i group. The 12-month absolute risks for RASi discontinuation were 19.1% in the GLP-1 RA group and 17.2% in the DPP-4i group.
IN PRACTICE:
“Treatment with GLP-1 RAs may enable wider use of the guideline-recommended cardioprotective and renoprotective medications and contribute to improving clinical outcomes in this population,” the authors wrote.
SOURCE:
The study was led by Tao Huang, MSc, Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China. It was published online on August 12, 2024, in JAMA Internal Medicine.
LIMITATIONS:
The study lacked data on confounders such as dietary potassium or the use of potassium-containing supplements. The definition of the duration of diabetes was a proxy because of the absence of medical records before 1997. The findings may have limited generalizability to other regions with larger ethnic variations owing to the absence of data on race and ethnicity.
DISCLOSURES:
This study was supported by the National Natural Science Foundation of China, the Swedish Research Council, the Swedish Heart Lung Foundation, and the US National Institutes of Health. One author reported receiving grants from various pharmaceutical companies unrelated to and outside the submitted work.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Source link : https://www.medscape.com/viewarticle/glp-1-ras-reduce-hyperkalemia-risk-prolong-rasi-use-2024a1000f34?src=rss
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Publish date : 2024-08-16 11:03:21
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