홍빈 (성균관대학교)

한빛사논문

조회132

성균관대학교

Ann. Intern. Med., Aug 27 2024, | https://doi.org/10.7326/M23-3220 Sodium-Glucose Cotransporter-2 Inhibitors, Dulaglutide, and Risk for Dementia : A Population-Based Cohort Study

Bin Hong ¹, Sungho Bea², Hwa Yeon Ko ¹, Woo Jung Kim ³, Young Min Cho ⁴, Ju-Young Shin ⁵

¹School of Pharmacy, Sungkyunkwan University, Suwon, South Korea (B.H., H.Y.K.).

²School of Pharmacy, Sungkyunkwan University, Suwon, South Korea, and Division of Pharmacoepidemiology and Pharmacoeconomics,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (S.B.).

³Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin; Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul; and Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, South Korea (W.J.K.).

⁴Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (Y.M.C.).

⁵School of Pharmacy and Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea (J.-Y.S.).

Corresponding Author: Ju-Young Shin, PhD

Abstract

Both sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may have neuroprotective effects in patients with type 2 diabetes (T2D). However, their comparative effectiveness in preventing dementia remains uncertain. To compare the risk for dementia between SGLT2 inhibitors and dulaglutide (a GLP-1 RA). Target trial emulation study. Nationwide health care data of South Korea obtained from the National Health Insurance Service between 2010 and 2022. Patients aged 60 years or older who have T2D and are initiating treatment with SGLT2 inhibitors or dulaglutide. The primary outcome was the presumed clinical onset of dementia. The date of onset was defined as the year before the date of dementia diagnosis, assuming that the time between the onset of dementia and diagnosis was 1 year. The 5-year risk ratios and risk differences comparing SGLT2 inhibitors with dulaglutide were estimated in a 1:2 propensity score-matched cohort adjusted for confounders. Overall, 12 489 patients initiating SGLT2 inhibitor treatment (51.9% dapagliflozin and 48.1% empagliflozin) and 1075 patients initiating dulaglutide treatment were included. In the matched cohort, over a median follow-up of 4.4 years, the primary outcome event occurred in 69 participants in the SGLT2 inhibitor group and 43 in the dulaglutide group. The estimated risk difference was -0.91 percentage point (95% CI, -2.45 to 0.63 percentage point), and the estimated risk ratio was 0.81 (CI, 0.56 to 1.16). Residual confounding is possible; there was no adjustment for hemoglobin A_1c levels or duration of diabetes; the study is not representative of newer drugs, including more effective GLP-1 RAs; and the onset of dementia was not measured directly. Under conventional statistical criteria, a risk for dementia between 2.5 percentage points lower and 0.6 percentage point greater for SGLT2 inhibitors than for dulaglutide was estimated to be highly compatible with the data from this study. However, whether these findings generalize to newer GLP-1 RAs is uncertain. Thus, further studies incorporating newer drugs within these drug classes and better addressing residual confounding are required. Ministry of Food and Drug Safety of South Korea.

논문정보

형식Research article
게재일2024년 08월 (BRIC 등록일 2024-09-02)
연구진국내(교신)+국외 연구진
분야 의약학 > 약학

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