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Experts showed mixed preferences between 2 diabetes treatments
  • By Kim Yun-mi
  • Published 2020.07.06 14:20
  • Updated 2020.07.06 14:20
  • comments 0

Two classes of drugs -- sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) – have emerged as the hottest diabetes treatment recently.

Between the two, SGLT-2 inhibitors are superior to GLP-1 RAs because they are less costly and more convenient to take, an expert claimed.

Park Jeong-hyun, a professor at the Endocrinology Department/Diabetes Center of Inje University Busan Paik Hospital, said SGLT-2 inhibitors are better treatment than GLP-1 RAs in offering cardiovascular benefits.

Park Jeong-hyun, a professor at the Endocrinology Department/Diabetes Center of Inje University Busan Paik Hospital, said so during a debate on which drug classes were better at a conference organized by the Korean Society of Cardiology (KSC) on Friday.

He cited a U.S. paper on a meta-analysis of the two drug classes, published in the Journal of the Endocrine Society in March. In the study, researchers conducted the meta-analysis on SGLT-2 inhibitors and GLP-1 RAs in recent cardiovascular outcome trials (CVOTs). The meta-analysis included six trials on GLP-1 RAs and four studies on SGLT-2 inhibitors involving 85,219 patients.

The results showed that GLP-1 RA and SGLT-2 inhibitor classes had a similar reduction in the major adverse cardiovascular event (MACE), cardiovascular deaths (CVD), and renal outcomes. However, SGLT-2 inhibitors had advantages over GLP-1 RAs in reducing hospitalization for heart failure (HHF).

“GLP-1 RAs proved efficacy in reduction of MACE. Some may say SGLT-2 inhibitors’ cardiovascular benefit resulted from the prevention of heart failure,” Park said. “But the local incidence of heart failure is rising. Even if we prevent stages before cardiovascular disease, a failure to prevent heart failure cannot stop death.”

The curve of sales of diabetes treatments in Denmark shows that sales of SGLT-2 inhibitors increased faster than those of GLP-1 RAs.

Park also argued that GLP-1 RAs are expensive injections, introducing the sales curve of diabetes treatments in Denmark.

He said patients usually are reluctant to get injections, whether once a day or once a week, and that is why they hesitate to get insulin treatment.

In Denmark, sales of GLP-1 RAs and SGLT-2 inhibitors are both increasing, but the curve of SGLT-2 inhibitors is much steeper, he emphasized.

Both SGLT-2 inhibitors and GLP-1 RAs have opened a new chapter in diabetes treatment, beyond the effect of blood glucose control that conventional drugs have shown, Park said. However, to expect a more “holistic” cardiovascular benefit in clinical settings, physicians should choose SGLT-2 inhibitors in terms of effectiveness, convenience in taking the medication, and low cost.

In contrast, Kim Byung-joon, a professor at the Endocrinology Department of Gachon University Gil Medical Center, said he preferred GLP-1 RAs.

The two drug classes are different medicines – one is oral, and the other is an injection, Kim said.

Even if both were assumed to be oral, the clinical significance of the two drugs would be different because GLP-1 RAs showed cardiovascular benefits through MACE reduction, while SGLT-2 inhibitors demonstrated cardiovascular benefits through hospitalization for heart failure.

“Choosing GLP-1 RA, which is directly related to the early stage myocardial mechanism, is a more helpful option,” Kim said.


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