Cardiovascular and Renal Outcomes with Efpeglenatide in Type 2 Diabetes.
Four glucagon-like peptide-1 (GLP-1) receptor agonists have been known to reduce the risk of adverse cardiovascular events in type 2 diabetic patients but the effect of efpeglenatide, an exendin-based GLP-1 receptor agonist on cardiovascular and renal outcomes in this patient is unknown. Hertzel C. Gerstein and colleagues conducted research under the title “Cardiovascular and Renal Outcomes with Efpeglenatide in Type 2 Diabetes” published in the New England Journal of Medicine. The summary of this article is given below:
Objective:
To assess the effect of efpeglenatide, on cardiovascular and renal outcomes in patients with Type 2 diabetes.
Method:
This is a randomized, placebo-controlled trial conducted at 344 sites across 28 countries. The participants who had type 2 diabetes and either a history of cardiovascular disease or present kidney disease plus along with at least one other cardiovascular risk factor were selected. Participants were divided to receive weekly subcutaneous injections of efpeglenatide at a dose of 4 or 6 mg or placebo randomly in a 1:1:1 ratio. Randomization was conducted according to the use of sodium-glucose cotransporter 2 inhibitors. The main outcome was the first major adverse cardiovascular event (MACE) i.e. a nonfatal stroke, composite of nonfatal myocardial infarction, or death from cardiovascular or undetermined causes.
Findings:
The study suggests that efpeglenatide administration is beneficial for cardiovascular and renal outcomes in type 2 diabetic patients with a history of cardiovascular disease or current kidney disease. Additionally, this benefit was found to be independent of the baseline use of metformin, the baseline use of SGLT2 inhibitors, and the baseline eGFR. While the participants in both efpeglenatide groups had reported gastrointestinal adverse events, there was no evidence of pancreatic, retinal, or thyroid-related events.
Limitation:
Some limitations of the study acknowledged by authors are: first short follow up period with the primary outcome being observed in a smaller number of participants than expected. Secondly, the selection of participants with a previous cardiovascular events or kidney disease limits the generalization of study findings to other populations.
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