New analyses from the LEADER study indicated that the CV benefits of liraglutide in patients with diabetes were consistent regardless of chronic kidney disease, prior MI or prior stroke.
As Cardiology Today previously reported , in the main results of the LEADER trial, liraglutide (Victoza, Novo Nordisk), a glucagon-like peptide-1 receptor agonist, was associated with lower risks for CV death, MI or stroke compared with placebo in 9,340 patients aged at least 50 years with poorly controlled type 2 diabetes.
In two analyses published in Circulation , researchers assessed whether the CV benefits of assignment to liraglutide in LEADER were consistent regardless of kidney function and whether they were consistent regardless of MI or stroke history.
For the kidney function analysis, Johannes F.E. Mann, MD, professor of medicine at KfH Kidney Center in Munich and the department of nephrology at Friedrich Alexander University of Erlangen, Germany, and colleagues stratified patients by estimated glomerular filtration rate (eGFR; < 60 mL/min/1.73 m 2 or 60 mL/min/1.73 m 2 ) and by whether they had albuminuria at baseline.
Mann and colleagues found the risk reduction associated with liraglutide for CV death/MI/stroke was greater in those with eGFR less than 60 mL/min/1.73 m 2 (HR = 0.69; 95% CI, 0.57-0.85) than in those with eGFR of at least 60 mL/min/1.73 m 2 (HR = 0.94; 95% CI, 0.83-1.07; P for interaction = .01).
The researchers did not find a consistent effect modification with liraglutide across more thoroughly stratified eGFR subgroups ( P for interaction = .13) or when eGFR was analyzed as a continuous variable ( P for interaction = .61).
The risk reduction associated with liraglutide for nonfatal stroke was significantly greater in patients with eGFR less than 60 mL/min/1.73 m 2 ( P for interaction = .004), whereas the risk reduction associated with nonfatal MI ( P for interaction = .19) and CV death ( P for interaction = .24) was numerically greater in those with impaired kidney function.
In addition, the risk reduction associated with liraglutide for CV death/MI/stroke was numerically but not significantly greater in those with baseline albuminuria vs. those without it ( P for interaction = .36), Mann and colleagues wrote.
“The present results demonstrate that the results of the LEADER trial on CV efficacy and
on safety of liraglutide apply to patients with [chronic kidney disease], which is clinically important given
that those patients with type 2 diabetes and [chronic kidney disease] have a high CV risk burden and few
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