Superior benefits of sodium‐glucose co‐transporter‐2 inhibitors compared with dipeptidyl peptidase‐4 inhibitors for diabetic kidney disease: A cohort study

• Published in: Diabetes, obesity & metabolism Vol. 27; no. 1; pp. 174 - 183
• Main Authors: Chen, Hsiao‐Ling, Wang, I‐Ting, Tsai, Yi‐Wen, Lee, Yu‐Hsuan, Chen, Chen‐Huan, Chiang, Chern‐En, Cheng, Hao‐Min
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.2025; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Antidiabetics; cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Cerebral infarction; Cohort analysis; Cohort Studies; Congestive heart failure; database research; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetic Nephropathies - drug therapy; Dipeptidyl-Peptidase IV Inhibitors - therapeutic use; Epidermal growth factor receptors; Female; Glomerular filtration rate; Glomerular Filtration Rate - drug effects; Glucose transporter; Heart failure; Humans; Kidney diseases; Male; Middle Aged; Myocardial infarction; pharmaco‐epidemiology; Population studies; real‐world evidence; Renal failure; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Taiwan - epidemiology; Treatment Outcome; Taiwan; cardiovascular disease; real‐world evidence; pharmaco‐epidemiology; database research
• ISSN: 1462-8902; 1463-1326; 1463-1326
• DOI: 10.1111/dom.15998

Aim To compare cardiorenal outcomes of dipeptidyl peptidase‐4 inhibitors (DPP‐4is) and sodium‐glucose co‐transporter‐2 inhibitors (SGLT‐2is) in a national diabetic kidney disease (DKD) population. Methods A cohort study was conducted using Taiwan's National Health Insurance Research Database and Laboratory Databases. Propensity score‐matched prevalent new users of SGLT‐2is (n = 1524) and DPP‐4is (n = 6005) during 2017‐2018 were selected from adults with DKD and an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73m2. Composite renal outcomes included sustained eGFR decrease, renal failure and renal mortality. Composite cardiovascular (CV) outcomes included acute myocardial infarction, stroke, hospitalization for heart failure and CV death. Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs). Results Compared with DPP‐4i users, SGLT‐2i users had a reduced risk of composite renal endpoint (HR: 0.16; CI: 0.12‐0.24), consistently for a prolonged time to 50% or higher eGFR decrease (HR 0.17; CI: 0.11‐0.27), renal failure (HR: 0.14; CI: 0.08‐0.23) and decreased renal death (HR: 0.10; CI: 0.01‐0.70). SGLT‐2i users had a better composite CV outcome than DPP‐4i users (HR: 0.74; CI: 0.64‐0.85), and lower risks of stroke (HR: 0.76; CI: 0.62‐0.92) and hospitalization for heart failure (HR: 0.68; CI: 0.55‐0.84). Findings were consistent in analyses stratified by concomitant antidiabetic agents or intervals between DKD diagnosis and study drug initiation. Conclusions This study shows the superior cardiorenal benefits of SGLT‐2is compared with DPP‐4is in the DKD population, regardless of concomitant antidiabetic agents or time from DKD onset to study drug initiation. SGLT‐2is should be prioritized in adult patients with DKD.