SOURCE: Mann JFE, Ørsted DD, Brown-Frandsen K, et al. N Engl J Med 2017;377:839-848.
Since 2008, the FDA has required all new diabetes medications to provide evidence of cardiovascular (CV) safety. The good news is that several classes of agents have demonstrated not only CV safety, but even efficacy in reducing CV events and (in some cases) all-cause mortality.
The glucagon-like peptide-1 receptor agonist (GLP-1 RA) liraglutide, the sodium-glucose co-transporter-2 inhibitors empagliflozin and canagliflozin, and the dopamine agonist bromocriptine have demonstrated beneficial effects on CV outcomes. Whether these results will be revealed as a class effect remains to be determined.
Alongside the favorable CV data, there is good news in relation to renal endpoints in some of these same trials, the most recent of which is reported from the liraglutide CV safety trial (LEADER). Renal outcomes showed favorable effects of liraglutide compared to placebo, primarily driven by a reduction in the number of patients who developed new macroalbuminuria (> 300 mg urinary albumin/24 hours). Similarly, the rate of decline in renal function, as measured by glomerular filtration rate, was statistically significantly less in patients treated with liraglutide than placebo.
Reductions in microvascular disease (early nephropathy, in the case of type 2 diabetes) has been a major justification for management of glucose for several decades. It is reassuring to confirm that the risk for more advanced nephropathy is ameliorated by use of liraglutide.