Cardiovascular and economic outcomes of combined liraglutide and empagliflozin therapy in type 2 diabetes: a 6-year study
J Thymis, G Oikonomidis, G Georgiopoulos, G Pavlidis, D Kourassis, G Kostelli, A Kountouri, V Lambadiari, I IkonomidisAbstract
Background
Type 2 Diabetes Mellitus (T2DM) yields high cardiovascular morbidity, resulting in overwhelming healthcare costs.
Purpose
We investigated whether the combined administration of the cardioprotective agent Glucagon-Like Peptide-1 receptor agonists (GLP1-RA) liraglutide and Sodium-Glucose Cotransporter-2 Inhibitor (SGLT2i) empagliflozin reduces the incidence of major adverse cardiovascular events and results in improved economic outcomes.
Methods
We prospectively enrolled (n=336) consecutive participants with T2DM, of which (n=94) received Insulin, (n=72) GLP1-RA, (n=82) SGLT2i and (n=78) their combination (GLP1-RA+SGLT2i). We obtained a comprehensive medical history and performed a clinical examination. Participants were strictly followed-up for six years. We recorded the occurrence of the adverse events the composite outcome of the non-fatal cardiac events: hospitalization for heart failure, myocardial infarction, stroke, coronary revascularization For cost effectiveness analysis of hospitalization for non fatal CV events we calculated the cost of treatment and the cost of hospitalization
Results
The median follow-up period was 69 [60 – 75] months, 252/336(75%) were males and were 60±10 years old. 134/336 (40%) had Coronary Artery Disease (CAD), 225/336 (67%) hypertension and 336/336(100%) hyperlipidemia. At follow-up, n=92 non-fatal events were documented, of which (n=22) myocardial infarctions, (n=23) heart failure hospitalizations, (n=7) strokes and (n=39) coronary revascularizations. Individuals under the combination displayed the lowest incidence of the composite outcome, heart failure hospitalization and revascularization (p<0.05) (Table). The combination group displayed the lowest risk for developing the composite outcome of non-fatal cardiovascular events after adjusting for age, sex, hypertension, hyperlipidemia, smoking and CAD (Insulin vs Combination group: Hazard ration (HR)=4.36, 95%CI:2.04-9.33, p<0.001;GLP1-RA vs Combination group: HR=2.45, 95%CI: 1.06-5.64, p=0.035; SGLT2i vs Combination group: HR=3.07, 95%CI: 1.38-6.81, p=0.006). The cost estimation of hospitalization for non-fatal CV events revealed that participants in the combination group displayed the lowest total Cost per patient per month through 80 months (Insulin: 562€, 95%CI: 344-781; GLP1-RA: 216€, 95%CI:36-396; SGLT2i:253€, 95%CI: 72-434; Combination:133 €, 95%CI: 0-266).
Conclusion
The combined administration of liraglutide and empagliflozin led to lower risk for non-fatal cardiovascular events in conjunction with better economic outcomes.TABLEGRAPH