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  • AMPLITUDE-O: efpeglenatide shows CV and renal benefits in T2DM

AMPLITUDE-O: efpeglenatide shows CV and renal benefits in T2DM

AMPLITUDE-O: efpeglenatide shows CV and renal benefits in T2DM

This cardiovascular outcomes trial evaluated efpeglenatide in 4076 participants with type 2 diabetes and either a history of cardiovascular (CV) disease or current kidney disease plus at least one other cardiovascular risk factor. Participants were randomly assigned 1:1:1 to receive weekly subcutaneous injections of efpeglenatide at a dose of 4 or 6 mg or placebo.

The primary outcome was the first major adverse cardiovascular event (MACE; a composite of non-fatal myocardial infarction, non-fatal stroke, or death from cardiovascular or undetermined causes). During a median follow-up of 1.81 years, efpeglenatide decreased the incidence of MACE by 27% (HR, 0.73; 95% CI, 0.58-0.92; P = 0.007 for superiority).

A composite renal outcome event (a decrease in renal function or macroalbuminuria) was reduced by 32% in patients treated with efpeglenatide (HR, 0.68; 95% CI, 0.57-0.79; P<0.001).

For the first time, a long-acting exendin analogue has shown cardiovascular and renal benefits in patients with type 2 diabetes, defying the concept that, within the GLP-1 (glucagon-like peptide 1) receptor agonists family, only human GLP-1 analogues were able to provide cardiovascular protection.

As with other GLP-1 receptor agonists, efpeglenatide significantly reduces several risk factors for cardiovascular and renal disease such as HbA1c and blood pressure, which the authors commented as possible pathways for protecting the heart and the kidneys, drawing on evidence from published mediation analysis of other GLP-1 receptor agonists that have suggested their cardiorenal benefits may be partially mediated by effects on HbA1c, blood pressure; and a meta-regression analysis of GLP-1 receptor agonists suggested a linear relation between lowering of HbA1c levels and reduced risks of MACE.

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Editorial Board

Image
Dr. Salvatore A. De Cosmo's image

Dr. Salvatore A. De Cosmo

Head of Unit of Internal Medicine and Endocrinology, Scientific Institute “Casa Sollievo della Sofferenza” San Giovanni, Rotondo, Italy
,
Image
Dr. Juan José Gorgojo Martínez's image

Dr. Juan José Gorgojo Martínez

Head of Department of Endocrinology and Nutrition, University Hospital Fundación, Alcorcon, Madrid, Spain
,
Image
Dr. Patrick Holmes' image

Dr. Patrick Holmes

General Practitioner, St. George's Medical Practice, Darlington, UK

Editorial Board

Image
Dr. Salvatore A. De Cosmo's image

Dr. Salvatore A. De Cosmo

Head of Unit of Internal Medicine and Endocrinology, Scientific Institute “Casa Sollievo della Sofferenza” San Giovanni, Rotondo, Italy
Image
Dr. Juan José Gorgojo Martínez's image

Dr. Juan José Gorgojo Martínez

Head of Department of Endocrinology and Nutrition, University Hospital Fundación, Alcorcon, Madrid, Spain
Image
Dr. Patrick Holmes' image

Dr. Patrick Holmes

General Practitioner, St. George's Medical Practice, Darlington, UK

Publication under Spotlight

Cardiovascular and Renal Outcomes with Efpeglenatide in Type 2 Diabetes

N Engl J Med
2021 June 28. DOI:
10.1056/NEJMoa2108269

Authors: Hertzel C Gerstein, Naveed Sattar, Julio Rosenstock, Chinthanie Ramasundarahettige, Richard Pratley, Renato D Lopes, Carolyn S P Lam, Nardev S Khurmi, Laura Heenan, Stefano Del Prato, Leanne Dyal and Kelley Branch

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