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Comparing Initiation of SGLT2i/GLP-1 RA Combination Therapy to Monotherapy

This article was originally published on PracticalCardiology.com.

A new study is providing clinicians with insight into the effects and clinical impact of initiation of combination with SGLT2 inhibitors and GLP-1 receptor agonists in real-world settings.

An analysis of nearly a decade’s worth of electronic medical record data, results of the study indicate combination therapy was generally well-tolerated and contributed to further reductions in risk of major adverse cardiovascular events than monotherapy with either agent.

Presented at the American College of Cardiology’s 71st Annual Scientific Sessions by Viet Le, PA-C, the study is representative of the recent explosion in knowledge surrounding the effects of antidiabetes medications in cardiometabolic diseases. Conducted with the intent of assessing contemporary trends in use and also tolerability of these agents when used in combination, Le and a team of colleagues from Intermountain Healthcare designed their study as a retrospective analysis of data from the Intermountain Healthcare electronic medical records.

Using the medical records and the MDClone ADAMS platform, investigators searched for patients with 5 or more encounters who initiated SGLT2 inhibitor use, GLP-1 RA use, or combined therapy between January 2012 and September 15, 2021. Among a cohort of 24,334 patients, investigator planned to assess the incidence of gastrointestinal adverse events in the first 30 days, differences in change in HbA1c at 3 and 6 months among the patient groups, and risk of adverse cardiovascular events. Of the 24,334 patients identified for inclusion, 6123 received combination therapy, 6733 received SGLT2 inhibitors alone, and 11,478 received GLP-1 RAs alone.

For incidence of gastrointestinal adverse events and gastrointestinal referrals, results suggested a greater incidence was observed among those who were initiating GLP-1 RA use than combination therapy. Further analysis suggested combination therapy was associated with additional improvements in HbA1c (-0.27%) and body weight (-1.11 kg) compared with monotherapy. Additionally, the risk of major adverse cardiovascular events observed during the follow-up period was lower with combination therapy, even after multivariable adjustment.

For more insight into the results of the trial and how they can inform real-world use of combination therapy, Practical Cardiology reached out to Le for his perspective on the data and findings.

This study, “Combination Therapy with Sodium-Glucose Cotransporter-2 inhibitors and Glucagon-Like Peptide-1 Receptor Agonists —Tolerability and Clinical Impact: The Intermountain Healthcare Real World Experience,” was presented at ACC.22.