Real-world data from CVD-REAL 2 demonstrates SGLT2 inhibitors benefits over DPP-4 inhibitors for CV risk reduction

First study to compare SGLT2 inhibitors with DPP-4 inhibitors for a broad range of cardiovascular (CV) outcomes shows that risk of CV events and death in adult patients with type 2 diabetes is lower in those newly initiated with SGLT2 inhibitors compared with those newly initiated on DPP-4 inhibitors.

In this comparative cohort analysis of the CVD-REAL 2 Multinational Cohort Study, health records from 13 countries and 4 major geographical regions (Asia-Pacific, Middle East, Europe and North America) were used. Following propensity score matching, 193,124 new users of SGLT2 inhibitors and 193,124 new users of DPP-4 inhibitors were included in the study population.

Initiation of SGLT2 inhibitors versus DPP-4 inhibitors, after a median follow-up of 1.2 years, demonstrated substantially lower risk of:

• Hospitalisation for heart failure (hazard ratio [HR]: 0.69, 95% confidence interval [CI]: 0.61-0.77; P<0.0001)
• All-cause death (HR: 0.59, CI: 0.52-0.67; P<0.0001)
• Composite of hospitalisation for heart failure or all-cause death (HR: 0.64, CI: 0.57-0.72; P<0.0001)
• Myocardial infarction (HR: 0.88, CI: 0.80-0.98; P = 0.020)
• Stroke (HR: 0.85, CI: 0.77-0.93; P = 0.0004)

Additionally, in the subset of patients without established CV disease (69.9%), SGLT2 inhibitors when compared with DPP-4 inhibitors also demonstrated significantly lower risks of CV outcomes. These results imply the CV benefits of SGLT2 inhibitors over DPP-4 inhibitors can be seen in both higher and lower CV risk populations.

Adding to the wealth of evidence of CV outcomes in SGLT2 clinical trials, these findings provide real-world evidence for the CV benefits of SGLT2 inhibitors compared with DPP4 inhibitors.

 

"All this evidence makes us wonder why DPP-4 inhibitors are still being prescribed more than SGLT-2 inhibitors all over the world, despite clear differences in cardiovascular and renal benefits and similar cost"

Dr. Gorgojo