PMID- 27003762
OWN - NLM
STAT- MEDLINE
DCOM- 20171107
LR  - 20221207
IS  - 1463-1326 (Electronic)
IS  - 1462-8902 (Linking)
VI  - 18
IP  - 8
DP  - 2016 Aug
TI  - Comparative cardiovascular safety of glucagon-like peptide-1 receptor agonists 
      versus other antidiabetic drugs in routine care: a cohort study.
PG  - 755-65
LID - 10.1111/dom.12665 [doi]
AB  - AIMS: To evaluate the comparative cardiovascular disease (CVD) safety of 
      glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in head-to-head comparisons 
      with dipeptidyl peptidase-4 (DPP-4) inhibitors, sulphonylureas or insulin, when 
      added to metformin, as used in 'real-world' patients with type 2 diabetes 
      mellitus (T2DM). METHODS: Within a large US commercial health plan database 
      linked to laboratory test results, we identified three pairwise 1 : 1 
      propensity-score-matched cohorts of patients with T2DM aged >/=18 years treated 
      with metformin who initiated a GLP-1 RA or a comparator, i.e. DPP-4 inhibitor (n 
      = 35 534), second-generation sulphonylureas (n = 28 138) or insulin (n = 47 068), 
      between 2005 and 2013. We examined the association between drug initiation and a 
      composite CVD endpoint, comprising hospitalizations for acute myocardial 
      infarction, unstable angina, stroke or coronary revascularization. RESULTS: 
      During the course of 1 year, there were 13.9 and 13.7 CVD events per 1000 
      person-years among propensity-score-matched initiators of GLP-1 RAs versus DPP-4 
      inhibitors [hazard ratio (HR) 1.02; 95% confidence interval (CI) 0.84-1.24]; and 
      12.1 versus 14.0 events among initiators of GLP-1 RAs versus sulphonylureas (HR 
      0.86; 95% CI 0.69-1.08). The effect estimates for GLP-1 RAs versus insulin were 
      sensitive to the adjustment for glycated haemoglobin, after which the HR was 1.01 
      (95% CI 0.73-1.41). Results were robust across several sensitivity analyses, 
      including an as-treated analysis considering up to 8.7 years of follow-up. 
      CONCLUSIONS: This large study, performing head-to-head comparisons of GLP-1 RAs 
      with other antidiabetic agents in real-world patients, provides estimates of 
      relative safety precise enough to exclude large differences in CVD risk and adds 
      further understanding to results from recent clinical trials.
CI  - (c) 2016 John Wiley & Sons Ltd.
FAU - Patorno, E
AU  - Patorno E
AD  - Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
FAU - Everett, B M
AU  - Everett BM
AD  - Divisions of Cardiovascular and Preventive Medicine, Department of Medicine, 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
FAU - Goldfine, A B
AU  - Goldfine AB
AD  - Clinical Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA, 
      USA.
FAU - Glynn, R J
AU  - Glynn RJ
AD  - Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
FAU - Liu, J
AU  - Liu J
AD  - Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
FAU - Gopalakrishnan, C
AU  - Gopalakrishnan C
AD  - Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
FAU - Kim, S C
AU  - Kim SC
AD  - Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, 
      Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
AD  - Division of Rheumatology, Allergy and Immunology, Brigham and Women's Hospital, 
      Harvard Medical School, Boston, MA, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20160502
PL  - England
TA  - Diabetes Obes Metab
JT  - Diabetes, obesity & metabolism
JID - 100883645
RN  - 0 (Dipeptidyl-Peptidase IV Inhibitors)
RN  - 0 (Glucagon-Like Peptide-1 Receptor)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Incretins)
RN  - 0 (Insulin)
RN  - 0 (Sulfonylurea Compounds)
RN  - 0 (hemoglobin A1c protein, human)
RN  - 9100L32L2N (Metformin)
SB  - IM
MH  - Adult
MH  - Angina, Unstable/*epidemiology
MH  - Cardiovascular Diseases/epidemiology
MH  - Cohort Studies
MH  - Databases, Factual
MH  - Diabetes Mellitus, Type 2/*drug therapy/metabolism
MH  - Dipeptidyl-Peptidase IV Inhibitors/therapeutic use
MH  - Drug Therapy, Combination
MH  - Female
MH  - Glucagon-Like Peptide-1 Receptor/agonists
MH  - Glycated Hemoglobin/metabolism
MH  - Hospitalization/statistics & numerical data
MH  - Humans
MH  - Hypoglycemic Agents/*therapeutic use
MH  - Incretins/*therapeutic use
MH  - Insulin/therapeutic use
MH  - Male
MH  - Metformin/*therapeutic use
MH  - Middle Aged
MH  - Myocardial Infarction/*epidemiology
MH  - Myocardial Revascularization/*statistics & numerical data
MH  - Propensity Score
MH  - Proportional Hazards Models
MH  - Retrospective Studies
MH  - Stroke/*epidemiology
MH  - Sulfonylurea Compounds/therapeutic use
OTO - NOTNLM
OT  - DPP-4 inhibitor
OT  - GLP-1 analogue
OT  - cardiovascular disease
OT  - insulin therapy
OT  - pharmaco-epidemiology
OT  - sulphonylureas
EDAT- 2016/03/24 06:00
MHDA- 2017/11/08 06:00
CRDT- 2016/03/23 06:00
PHST- 2015/12/29 00:00 [received]
PHST- 2016/01/23 00:00 [revised]
PHST- 2016/03/17 00:00 [accepted]
PHST- 2016/03/23 06:00 [entrez]
PHST- 2016/03/24 06:00 [pubmed]
PHST- 2017/11/08 06:00 [medline]
AID - 10.1111/dom.12665 [doi]
PST - ppublish
SO  - Diabetes Obes Metab. 2016 Aug;18(8):755-65. doi: 10.1111/dom.12665. Epub 2016 May 
      2.