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Patrick Holmes 💙

Jun 28, 2021 • 6 tweets • 6 min read • Read on X

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AMPLITUDE-O Trial
1/5
Cardiovascular outcome trial for Efpeglenatide an investigational once weekly Exendin-4 based GLP-1ra.

What are the unanswered questions
Do Exendin-based GLP-1a ⤵️ MACE❓
Do GLP-1ra ⤵️ MACE in people taking SGLT2i❓
Does GLP-1ra ⤵️ renal decline❓

#ADA2021

@DLBHATTMD

2/5
Main results

Efpeglenatide
⤵️3-point MACE by 27%
⤵️expanded MACE by 21%
⤵️Renal composite by 32%
⤵️MACE or non-CV death by 27%

Best data yet to suggest adding GLP-1ra to SGLT2i ⤵️MACE

@DLBHATTMD

3/5
Renal outcomes

Efpeglenatide
⤵️Renal composite
⤵️Albuminuria
⤵️eGFR slope❗️

4/5
How do these results impact on an updated GLP-1ra CVOT meta-analysis?

GLP-1ra
⤵️3-point MACE by 14%
⤵️CV ☠️ by 13%
⤵️MI by 10%
⤵️Stoke by 17%
⤵️hHF by 11%

5/5

Conclusions

Do Exendin-based GLP-1a ⤵️ MACE?✅
Do GLP-1ra ⤵️ MACE in people taking SGLT2i?✅ (⚠️small numbers though)
Does GLP-1ra ⤵️ renal decline?✅

Full slide set
👇
phri.ca/research/ampli…

Full paper
👇
nejm.org/doi/full/10.10…

Oops. Wong images attached 🤦‍♂️

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Patrick Holmes 💙

@drpatrickholmes

Jun 29, 2021

1/6
#ADA2021
Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE)

Q. What next after metformin?

MET plus:
✅GLP-1ra (liraglutide)
✅Insulin(glargine)
✅SU (glimepiride)
✅DPP4i (sitagliptin)

But
😱 No SGLT2i
😱 No TZD

care.diabetesjournals.org/content/36/8/2…

2/6
Mean baseline characteristics

57 yr old
♀️36%
66%👴🏻, 20%👴🏿
BMI 34
HbA1c 7.5%
Duration of diabetes 4.2 yr

⚠️🇺🇸 only study
⚠️only 3.6% from 'Asian' descent
⚠️ So not representative to non-🇺🇸 #type2diabetes

care.diabetesjournals.org/content/42/11/…

3/6
Summary of glycaemic outcomes

🥳GLP-1ra & Basal Insulin did best

💩DPP4i did worse. In particular if baseline HbA1c>7.8%

Bottom line - I don't think DPP-4i is a good option if HbA1c >7.8% (62mmol/mol)

📷courtesy of Prof. Matthews

Read 6 tweets

Patrick Holmes 💙

@drpatrickholmes

Jun 28, 2021

@Bayer

#ADA2021
1/6
✅Real world data from a 🇩🇪register of patients with ♂️#hypogonadism & #type2diabetes over 12 years!

❗️ ♂️ hypogonadism is common in T2D (≈ 50%)

⚠️@Bayer presented
⚠️ other data shown ⤴️ MACE
amjmed.com/article/S0002-…

So what did they find?

2/6

Baseline Characteristics.

🤔As you can see two very different cohorts of patients.

⚠️ High risk of unresolved bias

3/6

Changes in testosterone and glycaemic markers over time.

Testosterone therapy assoc with

⤴️ Testosterone
⤵️ HbA1c

Read 6 tweets

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