Thread by @MayoPharmRes

PGY2 Ambulatory care resident @laurel_pharmd will explore updated evidence for SGLT2 inhibitors and GLP-1 Receptor Agonists in renal and cardiovascular outcomes. Tune in here at 11 am CST for live tweets! #TwitteRx

The burden of cardiovascular and renal disease remains high in patients with diabetes. In the past year alone, the FDA has approved new indications for several existing antidiabetic agents within the #SGLT2 inhibitor and #GLP-1RA classes💊

There are numerous FDA approvals for SGLT2i and GLP-1RA for indications other than #diabetes. Approvals made within this past year are depicted with bold font 🗒️

DAPA-HF is a recent study that demonstrated an improvement in the composite of worsening HF or CV death ❤️ in patients with OR without diabetes. In contrast to most previous literature, this gives us new insight into these agents beyond A1C.

In DAPA-HF, the results of the primary outcome were very similar in patients with or without DM. However, the differences seen in subgroups based on severity of HF/the use of sacubitril-valsartan showed a lessened effect of the treatment.🤔 This is an area of continued research.

SUSTAIN-6 was a non-inferiority trial that demonstrated #semaglutide was non-inferior to placebo at preventing the composite outcome of death from CV causes, nonfatal MI, or nonfatal stroke. Most of that difference was attributed to a significant reduction in nonfatal stroke.

The REWIND trial showed that in patients with a history of cardiovascular disease AND in those at high risk (no prior history), #dulaglutide may reduce cardiovascular events.

With results just published weeks ago, the EMPEROR-reduced trial demonstrated very similar effects to DAPA-HF!

Looking at agents FDA approved for diabetic kidney disease, the list is much shorter than those approved for cardiovascular disease. #Canagliflozin was the first agent approved for DKD in the past 2 decades!

The CREDENCE trial was designed to specifically include renal outcomes as a primary endpoint.

To summarize recent updates, consider these factors if deciding to start and SGLT2i or GLP-1RA:

In patients where either an SGLT2i or GLP-1RA would be an appropriate option, there are other factors that should weigh⚖️ into the decision to select or avoid a particular class.

Recent update: the FDA has removed a boxed warning for canagliflozin and increased amputation risk.

Several ongoing trials are exploring additional outcomes in renal and cardiovascular diseases. EMPEROR-preserved and PRESERVED-HF will examine the effects of SGLT2i in #HFpEF, while DAPA-CKD and EMPA-KIDNEY will look at renal benefits. Many exciting developments to come!

With assessment of medications, comorbidities, and overall medication burden, adding of one of these agents may benefit patients. Thank you @laurel_pharmd for sharing such recent information!

Next week Hannah Poppen will present on non-statin therapy for #cholesterol management.