Cardiometabolic & kidneyResearch article
Estimated Lifetime Cardiovascular, Kidney, and Mortality Benefits of Combination Treatment With SGLT2 Inhibitors, GLP-1 Receptor Agonists, and Nonsteroidal MRA Compared With Conventional Care in Patients With Type 2 Diabetes and Albuminuria
- Modelling study (actuarial analysis of pooled trial data)
- data from 2 SGLT2i, 2 nonsteroidal mineralocorticoid receptor antagonist (ns-MRA) and 8 GLP-1 RA trials
- actuarial methods
Authors' conclusion
In patients with type 2 diabetes and at least moderately increased albuminuria, combination treatment of SGLT2i, GLP-1 RA, and ns-MRA has the potential to afford relevant gains in cardiovascular and kidney event-free and overall survival.
Study context
- Population
- Patients with T2DM and at least moderately increased albuminuria (urinary albumin:creatinine ratio ≥30 mg/g)
- Comparison
- Combination SGLT2i + GLP-1 RA + ns-MRA vs conventional care
- Outcome
- MACE:
- Nonfatal MI
- Nonfatal stroke
- CV death
Main finding
As reported in the abstract
MACE
Combination therapy vs Conventional careHazard ratio (95% CI)
MACE
0.65(0.55–0.76)
Combination therapy vs Conventional careAbsolute risk reduction (95% CI)
over 3 years
4.4%(3.0–5.7)
- over 3 years
- NNT 23 (95% CI 18–33)
Further findings
MACE absolute risk reduction and NNT · 3 years
- Estimated absolute risk reduction
- 4.4% (95% CI, 3.0-5.7)
- NNT
- 23 (95% CI, 18-33)
Projected gains in event-free survival (50-year-old patient)
years
- Hospitalized HF-free survival gain
- 3.2 (95% CI, 2.4-4.0)
- CKD progression-free survival gain
- 5.5 (95% CI, 4.0-6.7)
- CV death-free survival gain
- 2.2 (95% CI, 1.2-3.0)
- All-cause death-free survival gain
- 2.4 (95% CI, 1.4-3.4)
Event-free survival gains assuming 50% additive effects of combination therapy
years
- MACE-free survival gain
- 2.4 (95% CI, 1.1-3.5)
- CKD progression-free survival gain
- 4.5 (95% CI, 2.8-5.9)
- All-cause death-free survival gain
- 1.8 (95% CI, 0.7-2.8)
- attenuated but clinically relevant gains
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Estimated Lifetime Cardiovascular, Kidney, and Mortality Benefits of Combination Treatment With SGLT2 Inhibitors, GLP-1 Receptor Agonists, and Nonsteroidal MRA Compared With Conventional Care in Patients With Type 2 Diabetes and Albuminuria. Circulation. Published 12 November 2023. doi:10.1161/circulationaha.123.067584
Summarised from the published abstract; every number is checked against it