The glucagon-like peptide 1 analogue liraglutide improves renal outcomes in type 2 diabetics, according to new data from the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial. LEADER previously showed that the drug reduces the risk of cardiovascular (CV) disease, stroke, and death in type 2 diabetics. Subsequently, investigators continued the trial to study renal outcomes, too. More than 9,300 type 2 diabetics were randomized to receive liraglutide or placebo for almost four years. The primary outcome was a composite outcome of new-onset persistent macroalbuminuria, persistent doubling of the serum creatinine level, end-stage renal disease, or death due to renal disease. The outcome occurred less frequently in the liraglutide group than in the placebo group (268 of 4,668 liraglutide patients vs. 337 of 4,672 placebo patients; hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.67-0.92; P = 0.003), driven primarily by less microalbuminuria. Adverse effects were no higher in the liraglutide group. The authors concluded that when added to usual care for type 2 diabetes, liraglutide resulted in lower rates of the development and progression of diabetic kidney disease than placebo. (N Engl J Med 2017;377:839-848)

Based on the LEADER trial, the FDA has approved a new indication for liraglutide: to reduce the risk of major adverse CV events, heart attack, stroke, and CV death in adults with type 2 diabetes and established CV disease. LEADER showed that a composite of CV death, nonfatal myocardial infarction, or nonfatal stroke was reduced by 13% (P = 0.01). The absolute risk reduction was about 2% for the composite endpoint and 1.3% for death. (N Engl J Med 2016;375:311-322)