Abstract 12343: A Real-World Disproportionality Analysis of Atrial Fibrillation Adverse Events for Glucagon Like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase-4 Inhibitors

Abstract

Introduction: Diabetes mellitus (DM) is a known risk factor for atrial fibrillation (AF). Anti-diabetic agents such as metformin and sodium glucose co-transporter-2 inhibitors have been proven to have a protective role against AF. Recent data suggest that glucagon-like peptide-1 receptor agonists (GLP-1 RA) do not increase the risk of AF whereas evidence regarding dipeptidyl peptidase-4 inhibitors (DPP-4i) is limited. We sought to examine the association between AF and GLP-1 RA, DPP-4i using the Food and Drug Administration’s Adverse Event Reporting System (FAERS) database. Hypothesis: We hypothesized that GLP-1 RA and DPP-4i may have a protective role against AF. Methods: We interrogated the FAERS database for reports of AF in patients on linagliptin, sitagliptin, saxagliptin, and alogliptin in the DPP-4i group and exenatide, liraglutide, dulaglutide, albiglutide, and semaglutide in the GLP-1 RA group. Number of AF events reported for each drug were collected and compared with all the other drugs in the FAERS database. Disproportionality analysis was performed using the reporting odds ratio (ROR). Results: We identified a total of 159,901 and 44,071 adverse event reports in the GLP-1 RA and DPP-4i groups, respectively. The reporting of AF was significantly lower for GLP-1 RA compared to all other drugs in FAERS (ROR 0.56; 95% CI 0.49-0.63). The reporting of AF was significantly higher in DPP-4i (ROR 2.02; 95% CI 1.76-2.33). Saxagliptin demonstrated the highest reporting of AF (ROR 2.67; 95% CI 2.00-3.57) followed by linagliptin (ROR 1.87; 95% CI 1.41-2.47) in DPP-4i group. Conclusions: The reporting frequency of AF was significantly lower in GLP-1 RA group. This complements the existing evidence and alludes to the protective role of GLP-1 RA against AF. In contrast, the reporting frequency of AF was significantly higher in DPP-4i group, especially with saxagliptin and linagliptin. Validation with larger prospective clinical data is needed to confirm these findings.