More Clinical Benefits With Tirzepatide vs GLP-1 RA in T2D

TOPLINE:
In patients with type 2 diabetes (T2D), tirzepatide is associated with a reduced risk for all-cause mortality, major adverse cardiovascular events (MACEs), major adverse kidney events, and acute kidney injury compared with glucagon-like peptide 1 receptor agonists (GLP-1 RAs).
METHODOLOGY:
GLP-1 RAs are associated with improved kidney and cardiovascular outcomes beyond their intended hypoglycemic effects, but it is unknown how those outcomes compare with those of tirzepatide, a dual GLP-1 and glucose-dependent insulinotropic polypeptide RA.
This retrospective cohort study aimed to investigate the comparative association of tirzepatide vs GLP-1 RAs with mortality and adverse cardiovascular and kidney outcomes in patients with T2D.
Researchers analyzed data from the US Collaborative Network of TriNetX of 140,308 patients with T2D who were initiated on tirzepatide or a GLP-1 RA between June 1, 2022, and June 30, 2023.
The patients were grouped into two cohorts (tirzepatide and all other GLP-1 RAs), propensity matched for multiple variables (n = 14,832 in each group), and followed for a median duration of 10.5 months.
The primary outcome was all-cause mortality, with secondary outcomes including MACEs, kidney events, acute kidney injury, and major adverse kidney events. Changes in A1c and body weight were evaluated.
TAKEAWAY:
Tirzepatide was associated with a 42% lower risk for all-cause mortality than GLP-1 RAs (adjusted hazard ratio, 0.58; 95% CI, 0.45-0.75).
Patients treated with tirzepatide had a 20%, 48%, 22%, and 46% lower risk for MACEs, kidney events, acute kidney injuries, and major adverse kidney events, respectively, compared with those treated with GLP-1 RAs (all P < .001).
In terms of other effects, patients on tirzepatide also showed a greater reduction in A1c levels (treatment difference, −0.34 percentage points; 95% CI, −0.44 to −0.24) and body weight (treatment difference, −2.9 kg; 95% CI, −4.8 to −1.1 kg) over 20 months than those on GLP-1 RA therapy.
When stratified by dose, treatment with ≥ 10 mg tirzepatide was associated with a lower risk for all-cause mortality, MACEs, and major adverse kidney events than treatment with ≤ 7.5 mg tirzepatide.
IN PRACTICE:
“These insights advocate for the integration of tirzepatide into therapeutic strategies for managing type 2 diabetes and highlight its potential to enhance current clinical practice,” the authors wrote.
SOURCE:
This study was led by Min-Hsiang Chuang, MD, Chi Mei Medical Center, Tainan City, Taiwan. It was published online on August 12, 2024, in JAMA Network Open.
LIMITATIONS:
The study’s reliance on registry-based data may have led to the misidentification and underrepresentation of mild cases or individuals not engaged with the healthcare system. Treatment duration could not be ascertained, precluding the analysis of long-term effects. The study population was relatively healthy, limiting the generalizability of the findings to other clinical settings. The observational nature of the study and differing baseline characteristics between the groups means residual confounding cannot be eliminated entirely.
DISCLOSURES:
The study did not receive any funding. The authors declared no conflicts of interests.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
 
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