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One or two? Comparison of the cardiorenal effects between combination therapy and monotherapy with SGLT2i or GLP1RA

Mengqing Zhang1, Chu Lin1, Xiaoling Cai1

  • 1Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.

Diabetes, Obesity & Metabolism
|November 21, 2024
PubMed
Abstract

Insights

Combining sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) significantly reduces cardiorenal risks in type 2 diabetes patients. This combination therapy offers greater benefits than using either SGLT2i or GLP-1RA alone.

Area of Science:

  • Cardiology
  • Nephrology
  • Endocrinology

Background:

  • Type 2 diabetes (T2D) is associated with significant cardiovascular and renal complications.
  • Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) are established therapies for T2D management.
  • The combined cardiorenal effects of SGLT2i and GLP-1RA in T2D patients warrant comprehensive evaluation.

Purpose of the Study:

  • To evaluate the cardiorenal outcomes of combination therapy with SGLT2i and GLP-1RA.
  • To compare the efficacy of combined SGLT2i and GLP-1RA therapy against monotherapy with either agent in T2D patients.

Main Methods:

  • Systematic literature search of PubMed, Web of Science, Embase, Cochrane, and ClinicalTrials.gov up to June 2024.
  • Inclusion of randomized controlled trials and observational studies comparing combination therapy with SGLT2i or GLP-1RA monotherapy.
  • Meta-analysis using random-effects models to compute pooled relative risks (RR) and 95% confidence intervals (CIs).

Main Results:

  • Combination therapy significantly reduced composite cardiovascular outcomes compared to SGLT2i monotherapy (RR=0.57) and GLP-1RA monotherapy (RR=0.77).
  • Composite renal adverse events were less frequent with combination therapy versus SGLT2i (RR=0.69) or GLP-1RA monotherapy (RR=0.66).
  • Combination therapy showed lower risks of heart failure (RR=0.63) and all-cause mortality (RR=0.66) compared to GLP-1RA monotherapy.

Conclusions:

  • Combination therapy of SGLT2i and GLP-1RA demonstrates magnified cardiorenal benefits in T2D patients compared to monotherapy.
  • These findings suggest a synergistic effect of combining SGLT2i and GLP-1RA for improved patient outcomes.
  • Further research is recommended to validate these enhanced cardiorenal protective effects.
Keywords:
GLP‐1RASGLT2icardiorenal benefitcombination therapy

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