September 2023

Short-Term Costs in Patients with Chronic Kidney Disease Treated with Dapagliflozin: a Retrospective Cohort Study

Expert Rev Pharmacoecon Outcomes Res. 2023; online ahead of print DOI: 10.1080/14737167.2023.2237679

Analyses have found that dapagliflozin is cost-effective in the long term in patients with non-diabetic CKD and in patients with CKD with or without T2D. The slowing of eGFR decline and the early reduction in HF hospitalisation seen with dapagliflozin suggest that there is potential for short-term cost benefits in patients with CKD; however, there is a lack of real-world evidence. This retrospective observational cohort study described the impact of dapagliflozin on short-term medical costs in propensity matched patients with stage 3 CKD.

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July 2023

The Effects of Sodium-Glucose Cotransporter 2-Inhibitors on Steatosis and Fibrosis in Patients with Non-Alcoholic Fatty Liver Disease or Steatohepatitis and Type 2 Diabetes: A Systematic Review of Randomized Controlled Trials

Medicina (Kaunas). 2023;59:1136 DOI: 10.3390/medicina59061136

T2D and NAFLD/NASH share common causal pathways. As a class of glucose-lowering agents with well-established cardiovascular benefits, SGLT2i have been studied for effects on steatosis and fibrosis in patients with NAFLD or NASH. A systematic review was conducted to examine the efficacy of SGLT2i on NAFLD/NASH in patients who also had T2D.

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August 2023

The Impact of Obesity on Cardiovascular and Kidney Outcomes in Patients with Chronic Kidney Disease and Type 2 Diabetes Treated with Finerenone: Post hoc analysis of the FIDELITY Study

Diabetes Obes Metab. 2023 doi Epub ahead of print : 10.1111/dom.15197

Patients with obesity may benefit more from treatment with mineralocorticoid receptor antagonists given their higher levels of circulating aldosterone and therefore potentially higher levels of MRs in visceral fat. The aim of this analysis was to assess the effect of finerenone on the risk of cardiovascular and kidney outcomes in patients with chronic kidney disease and type 2 diabetes, with and without obesity.

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Safety of Sodium-Glucose Cotransporter 2 Inhibitors in Elderly Patients with Type 2 Diabetes: A Meta-Analysis of Randomised Controlled Trials

Diabetes Obes Metab 2023 DOI 10.1111/dom.15193

SGLT2is are effective in preventing adverse outcomes of heart failure and chronic kidney disease, which are highly prevalent in the elderly. While SGLT2is are generally well tolerated, elderly patients may be more susceptible to developing AEs reported with this class of drug, such as infections, fracture, and AKI. Clinical experience with SGLT2is in the elderly and very elderly is limited.

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November 2023

Mineralocorticoid Receptor Antagonist Use in Chronic Kidney Disease with Type 2 Diabetes: A Clinical Practice Document by the European Renal Best Practice (ERBP) Board of the European Renal Association (ERA)

Clin Kidney J. 2023;16:1885–1907

Patients with CKD and T2D are at high risk of both developing kidney failure and of CV events. With RAS blockers, residual risk of CKD progression remains high and no significant reduction in CV events and mortality has been seen in major studies in patients with CKD and T2D. Steroidal MRAs have been shown to reduce albuminuria in individuals on RAS monotherapy, but widespread clinical use is limited by the risk of hyperkalaemia and the absence of trials with hard renal outcomes. In recent years, non-steroidal MRAs have received increasing interest due to their better pharmacological profile, particularly finerenone, which effectively reduced CKD progression and CV outcomes in participants with T2D in Phase 3 trials.

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July 2023

Oral Semaglutide 50 mg Taken Once per Day in Adults with Overweight or Obesity (OASIS 1): a Randomised, Double-Blind, Placebo-Controlled, Phase 3 Trial

Lancet. 2023. DOI: 10.1016/S0140-6736(23)01185-6

Oral semaglutide 7 mg and 14 mg once-daily are approved for the treatment of T2D and improve glycaemic control with accompanying body weight reductions. A higher dose of once-daily oral semaglutide 50 mg is currently being investigated for the treatment of obesity in people with overweight or obesity, and for glycaemic control in people with T2D. The OASIS 1 trial assessed once-daily oral semaglutide 50 mg in adults with overweight or obesity, without T2D.

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Efficacy and Safety of Oral Orforglipron in Patients with Type 2 Diabetes: A Multicentre, Randomised, Dose-Response, Phase 2 Study

Lancet. 2023. DOI: 10.1016/S0140-6736(23)01302-8

Orforglipron, an oral, non-peptide GLP-1RA, was assessed at various once-daily doses (3 mg, 12 mg, 24 mg, 36 mg, 45 mg) and dose-escalation schedules vs placebo and dulaglutide in 383 patients with T2D, with or without metformin, and BMI ≥23 kg/m2, with no food or water restrictions.

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Keywords:

Efficacy and Safety of Co-Administered Once-weekly Cagrilintide 2.4 mg with Once-Weekly Semaglutide 2.4 mg in Type 2 Diabetes: a Multicentre, Randomised, Double-Blind, Active-Controlled, Phase 2 Trial

Lancet. 2023. DOI: 10.1016/ S0140-6736(23)01163-7

Combining the GLP-1 RA semaglutide with the long-acting amylin analogue cagrilintide has been shown to have weight-loss benefits. However, the impact of the combination of cagrilintide and semaglutide (CagriSema) on HbA1c is unknown. In a 32-week, double-blind, phase 2 trial, 92 adults with T2D and a BMI ≥27 kg/m2 on metformin, with or without an SGLT2i, were randomised to once-weekly subcutaneous CagriSema, semaglutide or cagrilintide (all escalated to 2.4 mg). 

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Effect of Semaglutide versus Other Glucagon-Like Peptide-1 Receptor Agonists on Cardio-Metabolic Risk Factors in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Head-to-Head, Phase 3, Randomized Controlled Trials

J Diabetes Complications. 2023;37:108529 DOI: 10.1016/j.jdiacomp.2023.108529

 GLP-1RAs vary in their abilities to control glycaemia, reduce body weight and improve other cardiometabolic risk factors. A recent systematic review and meta-analysis assessed the efficacy and safety of semaglutide compared with other GLP-1RAs in head-to-head phase 3 RCTs in adults with T2D.

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June 2023

Efficacy and Safety of Tirzepatide for Treatment of Overweight or Obesity. A Systematic Review and Meta-analysis

Int J Obes (Lond). 2023. DOI: 10.1038/s41366-023-01321-5

 This systematic review and meta-analysis aimed to assess the efficacy and safety of tirzepatide for weight loss in patients with overweight or obesity.

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