Prediction of the Effects of Liraglutide on Kidney and Cardiovascular Outcomes Based on Short-Term Changes in Multiple Risk Markers
Aims: The LEADER trial demonstrated that the glucagon-like peptide-1 receptor agonist (GLP1-RA) liraglutide reduces kidney and cardiovascular (CV) risk in patients with type 2 diabetes. We previously developed a Parameter Response Efficacy (PRE) score that translates multiple short-term risk marker...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-04-01
|
| Series: | Frontiers in Pharmacology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2022.786767/full |
| _version_ | 1818261671877017600 |
|---|---|
| author | Sok Cin Tye Sieta T. de Vries Johannes F. E. Mann Johannes F. E. Mann Meir Schechter Meir Schechter Ofri Mosenzon Ofri Mosenzon Petra Denig Hiddo J. L. Heerspink |
| author_facet | Sok Cin Tye Sieta T. de Vries Johannes F. E. Mann Johannes F. E. Mann Meir Schechter Meir Schechter Ofri Mosenzon Ofri Mosenzon Petra Denig Hiddo J. L. Heerspink |
| author_sort | Sok Cin Tye |
| collection | DOAJ |
| description | Aims: The LEADER trial demonstrated that the glucagon-like peptide-1 receptor agonist (GLP1-RA) liraglutide reduces kidney and cardiovascular (CV) risk in patients with type 2 diabetes. We previously developed a Parameter Response Efficacy (PRE) score that translates multiple short-term risk marker changes, from baseline to first available follow-up measurement, into a predicted long-term drug effect on clinical outcomes. The objective of this study was to assess the accuracy of the PRE score in predicting the efficacy of liraglutide in reducing the risk of kidney and CV outcomes.Methods: Short-term changes in glycated hemoglobin (HbA1c), systolic blood pressure (BP), urinary-albumin-creatinine-ratio (UACR), hemoglobin, body weight, high-density-lipoprotein (HDL) cholesterol, low-density-lipoprotein (LDL) cholesterol, and potassium were monitored in the LEADER trial. Associations between risk markers and kidney or CV outcomes were established using a multivariable Cox proportional hazards model in a separate pooled database of 6,355 patients with type 2 diabetes. The regression coefficients were then applied to the short-term risk markers in the LEADER trial to predict the effects of liraglutide on kidney (defined as a composite of doubling of serum creatinine or end-stage kidney disease) and CV (defined as a composite of non-fatal myocardial infarction, non-fatal stroke, and CV death) outcomes.Results: Liraglutide compared to placebo reduced HbA1c (1.4%), systolic BP (3.0 mmHg), UACR (13.2%), body weight (2.3 kg), hemoglobin (2.6 g/L), and increased HDL-cholesterol (0.01 mmol/L) (all p-values <0.01). Integrating multiple risk marker changes in the PRE score resulted in a predicted relative risk reduction (RRR) of 16.2% (95% CI 13.7–18.6) on kidney outcomes which was close to the observed RRR of 15.5% (95% CI -9.0–34.6). For the CV outcome, the PRE score predicted a 7.6% (95% CI 6.8–8.3) RRR, which was less than the observed 13.2% (95% CI 3.2–22.2) RRR.Conclusion: Integrating multiple short-term risk markers using the PRE score adequately predicted the effect of liraglutide on the composite kidney outcome. However, the PRE score underestimated the effect of liraglutide for the composite CV outcome, suggesting that the risk markers included in the PRE score do not fully capture the CV benefit of liraglutide. |
| first_indexed | 2024-12-12T18:50:56Z |
| format | Article |
| id | doaj.art-651f2f6b0524417a8a1c38ee807b41d5 |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-12-12T18:50:56Z |
| publishDate | 2022-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-651f2f6b0524417a8a1c38ee807b41d52022-12-22T00:15:22ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122022-04-011310.3389/fphar.2022.786767786767Prediction of the Effects of Liraglutide on Kidney and Cardiovascular Outcomes Based on Short-Term Changes in Multiple Risk MarkersSok Cin Tye0Sieta T. de Vries1Johannes F. E. Mann2Johannes F. E. Mann3Meir Schechter4Meir Schechter5Ofri Mosenzon6Ofri Mosenzon7Petra Denig8Hiddo J. L. Heerspink9Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, NetherlandsDepartment of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, NetherlandsKfH Kidney Center, Munich, GermanyDepartment of Medicine, Friedrich Alexander University, Erlangen, GermanyFaculty of Medicine, Hebrew University of Jerusalem, Jerusalem, IsraelDiabetes Unit, Hadassah Hebrew University Hospital, Jerusalem, IsraelFaculty of Medicine, Hebrew University of Jerusalem, Jerusalem, IsraelDiabetes Unit, Hadassah Hebrew University Hospital, Jerusalem, IsraelDepartment of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, NetherlandsDepartment of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, NetherlandsAims: The LEADER trial demonstrated that the glucagon-like peptide-1 receptor agonist (GLP1-RA) liraglutide reduces kidney and cardiovascular (CV) risk in patients with type 2 diabetes. We previously developed a Parameter Response Efficacy (PRE) score that translates multiple short-term risk marker changes, from baseline to first available follow-up measurement, into a predicted long-term drug effect on clinical outcomes. The objective of this study was to assess the accuracy of the PRE score in predicting the efficacy of liraglutide in reducing the risk of kidney and CV outcomes.Methods: Short-term changes in glycated hemoglobin (HbA1c), systolic blood pressure (BP), urinary-albumin-creatinine-ratio (UACR), hemoglobin, body weight, high-density-lipoprotein (HDL) cholesterol, low-density-lipoprotein (LDL) cholesterol, and potassium were monitored in the LEADER trial. Associations between risk markers and kidney or CV outcomes were established using a multivariable Cox proportional hazards model in a separate pooled database of 6,355 patients with type 2 diabetes. The regression coefficients were then applied to the short-term risk markers in the LEADER trial to predict the effects of liraglutide on kidney (defined as a composite of doubling of serum creatinine or end-stage kidney disease) and CV (defined as a composite of non-fatal myocardial infarction, non-fatal stroke, and CV death) outcomes.Results: Liraglutide compared to placebo reduced HbA1c (1.4%), systolic BP (3.0 mmHg), UACR (13.2%), body weight (2.3 kg), hemoglobin (2.6 g/L), and increased HDL-cholesterol (0.01 mmol/L) (all p-values <0.01). Integrating multiple risk marker changes in the PRE score resulted in a predicted relative risk reduction (RRR) of 16.2% (95% CI 13.7–18.6) on kidney outcomes which was close to the observed RRR of 15.5% (95% CI -9.0–34.6). For the CV outcome, the PRE score predicted a 7.6% (95% CI 6.8–8.3) RRR, which was less than the observed 13.2% (95% CI 3.2–22.2) RRR.Conclusion: Integrating multiple short-term risk markers using the PRE score adequately predicted the effect of liraglutide on the composite kidney outcome. However, the PRE score underestimated the effect of liraglutide for the composite CV outcome, suggesting that the risk markers included in the PRE score do not fully capture the CV benefit of liraglutide.https://www.frontiersin.org/articles/10.3389/fphar.2022.786767/fullliraglutidediabetesrisk markerskidney outcomescardiovascular outcomes |
| spellingShingle | Sok Cin Tye Sieta T. de Vries Johannes F. E. Mann Johannes F. E. Mann Meir Schechter Meir Schechter Ofri Mosenzon Ofri Mosenzon Petra Denig Hiddo J. L. Heerspink Prediction of the Effects of Liraglutide on Kidney and Cardiovascular Outcomes Based on Short-Term Changes in Multiple Risk Markers Frontiers in Pharmacology liraglutide diabetes risk markers kidney outcomes cardiovascular outcomes |
| title | Prediction of the Effects of Liraglutide on Kidney and Cardiovascular Outcomes Based on Short-Term Changes in Multiple Risk Markers |
| title_full | Prediction of the Effects of Liraglutide on Kidney and Cardiovascular Outcomes Based on Short-Term Changes in Multiple Risk Markers |
| title_fullStr | Prediction of the Effects of Liraglutide on Kidney and Cardiovascular Outcomes Based on Short-Term Changes in Multiple Risk Markers |
| title_full_unstemmed | Prediction of the Effects of Liraglutide on Kidney and Cardiovascular Outcomes Based on Short-Term Changes in Multiple Risk Markers |
| title_short | Prediction of the Effects of Liraglutide on Kidney and Cardiovascular Outcomes Based on Short-Term Changes in Multiple Risk Markers |
| title_sort | prediction of the effects of liraglutide on kidney and cardiovascular outcomes based on short term changes in multiple risk markers |
| topic | liraglutide diabetes risk markers kidney outcomes cardiovascular outcomes |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2022.786767/full |
| work_keys_str_mv | AT sokcintye predictionoftheeffectsofliraglutideonkidneyandcardiovascularoutcomesbasedonshorttermchangesinmultipleriskmarkers AT sietatdevries predictionoftheeffectsofliraglutideonkidneyandcardiovascularoutcomesbasedonshorttermchangesinmultipleriskmarkers AT johannesfemann predictionoftheeffectsofliraglutideonkidneyandcardiovascularoutcomesbasedonshorttermchangesinmultipleriskmarkers AT johannesfemann predictionoftheeffectsofliraglutideonkidneyandcardiovascularoutcomesbasedonshorttermchangesinmultipleriskmarkers AT meirschechter predictionoftheeffectsofliraglutideonkidneyandcardiovascularoutcomesbasedonshorttermchangesinmultipleriskmarkers AT meirschechter predictionoftheeffectsofliraglutideonkidneyandcardiovascularoutcomesbasedonshorttermchangesinmultipleriskmarkers AT ofrimosenzon predictionoftheeffectsofliraglutideonkidneyandcardiovascularoutcomesbasedonshorttermchangesinmultipleriskmarkers AT ofrimosenzon predictionoftheeffectsofliraglutideonkidneyandcardiovascularoutcomesbasedonshorttermchangesinmultipleriskmarkers AT petradenig predictionoftheeffectsofliraglutideonkidneyandcardiovascularoutcomesbasedonshorttermchangesinmultipleriskmarkers AT hiddojlheerspink predictionoftheeffectsofliraglutideonkidneyandcardiovascularoutcomesbasedonshorttermchangesinmultipleriskmarkers |