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Inhibidores de SGLT2 y agonistas de los receptores GLP-1: indicaciones establecidas y emergentes
Emily Brown1, Hiddo J L Heerspink2, Daniel J Cuthbertson1
1Department of Metabolic and Cardiovascular Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Liverpool University Hospitals NHS Foundation Trust, Longmoor Lane, Liverpool, UK.
Lancet (London, England)
|July 3, 2021
Resumen
Los inhibidores del cotransportador de sodio-glucosa-2 (SGLT2) y los agonistas de los receptores de péptidos similares al glucagón-1 (GLP-1) ofrecen una protección cardiovascular y renal significativa en pacientes con diabetes tipo 2. Estos agentes son cada vez más vitales para el manejo de la enfermedad cardiorrenal, incluso para aquellos que no tienen diabetes.
Área de la Ciencia:
- Cardiología
- Endocrinología
- Nefrología
Sus antecedentes:
- Los inhibidores del cotransportador de sodio-glucosa-2 (SGLT2) y los agonistas de los receptores de péptidos similares al glucagón-1 (GLP-1) son terapias establecidas para reducir la glucosa en la diabetes tipo 2.
- Estos medicamentos proporcionan beneficios adicionales que incluyen pérdida de peso, reducción de la presión arterial y protección cardiovascular significativa.
Objetivo del estudio:
- Revisar los beneficios establecidos y emergentes de los inhibidores de SGLT2 y los agonistas de los receptores GLP-1.
- Destacar su papel en el tratamiento de enfermedades cardiorenales y otras indicaciones clínicas.
Principales métodos:
- Revisión de los datos de los ensayos de resultados cardiovasculares.
- Análisis de las pruebas relativas a los perfiles de eficacia y seguridad.
- Discusión de las aplicaciones clínicas actuales y futuras.
Principales resultados:
- Los inhibidores de SGLT2 y los agonistas de los receptores de GLP-1 reducen los eventos cardiovasculares adversos importantes, las hospitalizaciones por insuficiencia cardíaca y la mortalidad.
- La investigación en curso tiene como objetivo aclarar los beneficios renoprotectores utilizando puntos finales renales duros.
- Existen contraindicaciones y precauciones específicas para cada clase de fármacos.
Conclusiones:
- Estos agentes son terapias cruciales de segunda o primera línea para pacientes con enfermedad cardiorrenal, independientemente del control glucémico.
- La priorización del tratamiento debe basarse en perfiles específicos de pacientes: agonistas de los receptores de GLP-1 para el riesgo cardiovascular, inhibidores de SGLT2 para la insuficiencia cardíaca o la enfermedad renal crónica.
- La evidencia convincente apoya su uso en pacientes con obesidad y sobrepeso con comorbilidades, incluso sin diabetes tipo 2.
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