Abstract 043: Real-World Evidence Demonstrating The Association Of SGLT2 Inhibitors With Reduced Cardiovascular Disease In Patients With Type 2 Diabetes

Abstract

Introduction: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are a class of antihyperglycemic drugs recommended to patients with type 2 diabetes (T2D) as a 2 nd line therapy after metformin. Recent evidence suggests they may reduce the risk for cardiovascular disease (CVD); however, prior studies have been clinical trials, which do not reflect real-world data, and did not conduct head-to-head comparisons of SGLT2 inhibitors. Therefore, utilizing data from the US MarketScan administrative databases in 2013-19, we tested the hypothesis that patients with T2D taking SGLT2 inhibitors have a lower risk of CVD compared to those taking other 2 nd line therapies. Methods: We included 313,626 patients with T2D who were taking metformin and a 2 nd line therapy (SGLT2 vs. other). SGLT2 inhibitor users were matched with up to 5 users of other 2 nd line therapies by age, sex, date of enrollment, and date of 2 nd line therapy initiation. The primary CVD outcome was a composite of stroke, atrial fibrillation, myocardial infarction, and heart failure. Patients with prevalent CVD were excluded. We also conducted head-to-head comparisons of SGLT2 inhibitors. Cox proportional hazards models were used to estimate hazard ratios (HR). Results: Participants were on average age 53±10 years at baseline and 47% were female. Median follow-up time was 1.4 years. After multivariable adjustments, SGLT2 inhibitor users had a lower risk of CVD than those taking other 2 nd line therapies [Table; HR (95% CI): 0.66 (0.62, 0.71)]. Significant associations were also observed when each CVD outcome was assessed separately, with the strongest associations for stroke and heart failure. No differences were observed when comparing individual SGLT2 inhibitors. Conclusion: Using MarketScan data in patients with T2D, we found that users of SGLT2 inhibitors had a lower risk of CVD compared to users of other 2 nd line therapies. By using real-world data, these findings complement clinical trial results supporting the effectiveness of SGLT2 inhibitors in reducing risk of CVD.