At the American College of Cardiology’s 74th Annual Scientific Session in Chicago, results from a study by O’Neill and colleagues were presented. The study investigated the potential of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in the treatment of atrial fibrillation (AF)/flutter and stroke. Type 2 diabetes (T2D) has been identified as being associated with an increased risk of cardiovascular (CV) mortality, and GLP-1RAs are being increasingly used as the main therapy in the treatment regimens for T2D and obesity. However, the effect of GLP-1Ras on the development of AF/flutter and stroke remains unknown. There is increasing clinical evidence demonstrating the efficacy of GLP-1 therapies such as tirzepatide and semaglutide in the treatment of CV diseases such as heart failure (HF) and major adverse cardiovascular events (MACE), usually in patients with T2D, obesity, and/or chronic kidney disease (CKD). This has created an increasing demand for clinical evidence showing whether GLP-1 therapies can be used for other CV disease such as AF, especially in combination with therapies such as sodium-glucose co-transporter-2 inhibitors (SGLT-2Is), which are prescribed for HF with or without T2D and CKD in addition to their traditional prescribing regimen for T2D. Key opinion leaders (KOLs) interviewed by GlobalData have noted their enthusiasm for therapies that address the broad spectrum of cardio-metabolic disease that is commonly found across T2D patients with or without CKD, HF, and obesity. Positive data for GLP-1s in the treatment of CV diseases such as AF and cerebrovascular disease (stroke) will contribute to the steadily increased prescribing rate for these therapies.
For this study, patients ages 18–90 years with T2D and a body mass index (BMI) of 27 or higher were identified from a large, multinational database, the TriNetX Network. Two cohorts were established based on the treatments patients received: SGLT2-I alone or SGLT-2I in combination with GLP-1RA. Demographic information and relevant comorbidity propensity matching were carried out, and a Kaplan-Meier curve was used to compare outcomes, including five-year rates for AF/flutter and stroke. Patients treated with SGLT-2I alone and with SGLT-2I in conjunction with GLP-1RAs were propensity-matched, yielding 165,411 patients in each cohort. Patients with T2D receiving GLP-1RA demonstrated a reduced incidence of AF (82.211% versus 83.533%, hazard ratio [HR] = 1.173; 95 % confidence interval [CI] 1.15, 1.196) and reduced incidence of stroke (91.962% versus 92.351, HR = 1.096, 95% CI 1.06, 1,13) when compared with patients treated with SGLT-2I alone.
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The study concluded that treatment with SGLT-2I in conjunction with GLP-1RA may help to reduce the incidence of AF/flutter and stroke in T2D patients. However, additional prospective studies are required to further elucidate the findings. GlobalData forecasts that with the increasing number of trials across the cardio-metabolic space for GLP-1RAs, both alone and in combination with SGLT2-Is, the GLP-1 class remains on track to be the leading drug class in the metabolic disease space.
