Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Lower Rates of Hospitalization for Heart Failure and All-Cause Death in Patients Newly Initiated on SGLT-2 Inhibitors versus other glucose lowering drugs: The CVD-REAL Study (#6)

Matthew Cavender 1 , Anna Norhammar 2 , John Wilding 3 , Kamlesh Khunti 4 , Alex Z Fu 5 , Reinhard W Holl 6 , Kåre I Birkeland 7 8 , Marit Eika Jørgensen 9 10 11 , Niklas Hammar 2 12 , Johan Bodegård 13 , Betina Blak 14 , Eric T Wittbrodt 15 , Sara Dempster 16 , Markus Scheerer 17 , Niki Arya 18 , Marcus Thuresson 19 , Peter Fenici 20 , Mikhail Kosiborod 21
  1. University of North Carolina, Charlotte, North Carolina, USA
  2. Karolinska Institutet, Solna, Stockhom, Sweden
  3. Institute of Ageing & Chronic Disease, Liverpool, UK
  4. Diabetes Research Centre, Leicester, UK
  5. Georgetown University Medical Center, Washington, DC, USA
  6. Institute for Epidemiology and Medical Biometry, University Ulm, Ulm, Germany
  7. University of Oslo, Oslo, Norway, Oslo, Norway
  8. Oslo University Hospital, Oslo, Norway
  9. Steno Diabetes Center , Copenhagen, Gentofte , Denmark
  10. National institute of Public Health , Southern Denmark University, Copenhagen, Denmark
  11. National institute of Public Health , Southern Denmark University, Copenhagen, Denmark
  12. AstraZeneca Gothenburg, Mölndal, Sweden
  13. AstraZeneca, Oslo, Norway
  14. AstraZeneca, Luton, UK
  15. AstraZeneca, Wilmington, Delaware, USA, Wilmington, Delaware, USA
  16. AstraZeneca, Waltham, Massachusetts, USA
  17. AstraZeneca, Wedel, Germany
  18. AstraZeneca, Gaithersburg, Maryland, USA
  19. Statisticon AB, Uppsala, Sweden
  20. AstraZeneca, Cambridge, UK
  21. Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, USA

Background: Reduction in cardiovascular death and hospitalization for heart failure (HHF) was recently reported with a sodium-glucose co-transporter-2 inhibitor (SGLT-2i) in Type 2 diabetes patients with cardiovascular disease. We compared HHF and death in new users of SGLT-2i versus other glucose lowering drugs (oGLDs) in six countries to determine if these benefits are seen in real-world practice, and across SGLT-2i class.

Methods: Data were collected via medical claims, primary care/hospital records and national registries. Propensity score for SGLT-2i initiation was used to match treatment groups. Hazard ratios (HRs) for HHF, death and a combined endpoint of HHF or death were estimated by country and pooled to determine weighted effect size.

Results: After propensity matching, there were 309,056 patients newly initiated on either SGLT-2i or oGLD (154,528 patients in each treatment group). Canagliflozin, dapagliflozin, and empagliflozin accounted for 53%, 42% and 5% of the total exposure time in the SGLT-2i class, respectively. Baseline characteristics were balanced between the two groups. There were 961 HHF cases among 309,056 patients with 190,164 person-years follow up (incidence rate [IR] 0.51/100 person-years). Of 215,622 patients in the US, Norway, Denmark, Sweden, and UK, death occurred in 1334 (IR 0.87/100 person-years), and HHF or death in 1983 (IR 1.38/100 person-years). Use of SGLT-2i, versus oGLDs, was associated with significantly lower rates of HHF (HR 0.61; 95% CI 0.51–0.73; p<0.001); death (HR 0.49; 95% CI 0.41–0.57; p<0.001); and HHF or death (HR 0.54; 95% CI 0.48–0.60, p<0.001) with no significant heterogeneity by country.

Conclusions: Treatment with SGLT-2i versus oGLDs in this large international study was associated with a significantly lower risk of HHF and death, suggesting a class effect applicable to a broad population of T2D patients in real-world clinical practice.