Type 2 Diabetes

Type 2 Diabetes: Dulaglutide Found Beneficial for CVD, CKD Outcomes

Dulaglutide, a glucagon-like peptide-1 receptor agonist, likely confers both cardiovascular and renal benefits in patients with type 2 diabetes, according to highly anticipated findings from 2 trials presented at the American Diabetes Association’s (ADA) 79th Scientific Sessions.

In a study of data from the Researching Cardiovascular Events With a Weekly Incretin in Diabetes (REWIND) trial, researchers found that dulaglutide was a viable option for the management of glycemic control in middle-aged and older patients with type 2 diabetes with previous cardiovascular disease (CVD) or cardiovascular risk factors.1


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“The REWIND trial was an ambitious study that conclusively assessed the effects of dulaglutide on people with type 2 diabetes both with and without prior [CVD],” said principal investigator Hertzel Gerstein, MD, MSc, professor of medicine, director of the division of endocrinology and metabolism, and deputy director of the Population Health Institute at McMaster University and Hamilton Health Sciences in Ontario, Canada, in a press release.2

By the end of the trial, the primary composite outcome of non-fatal myocardial infarction, non-fatal stroke, or mortality from cardiovascular causes, including unknown causes, had occurred in fewer dulaglutide-treated participants (n = 594 [12.0%] of 4949) than placebo-treated participants (n = 663 [13.4%] of 4952). No between-group difference in all-cause mortality was observed, the researchers noted.

“The reduction in cardiovascular events observed in a wide range of people with diabetes regardless of sex, [CVD], age, or A1c level is compelling,” Dr Gerstein said of the findings.2

In the AWARD-7 study, which was also presented at the ADA’s 79th Scientific Sessions, a 1.5-mg weekly dose of dulaglutide was shown to be a safe and effective treatment option among participants with type 2 diabetes and moderate to severe chronic kidney disease (CKD).3

“These results from AWARD-7 were particularly striking because of the marked reduction in clinical events with dulaglutide treatment among participants with moderate-to-severe chronic kidney disease who are already receiving the current standard-of-care (renin-angiotensin system inhibitors),” said lead investigator Katherine R. Tuttle, MD, executive director for research at Providence Health Care in Washington, in a press release.4

Specifically, the researchers found that 1.5 mg dulaglutide weekly had reduced recipients’ risk of a 40% or greater decline in estimated glomerular filtration rate (eGFR) or end-stage renal disease by more than half compared with insulin recipients.

“Until now, very few treatments have been shown to reduce the risk of end-stage-kidney disease and show an up to 40% eGFR decline at more advanced stages of chronic kidney disease,” said Dr Tuttle in a press release. “It is encouraging to see that newer glucose-lowering treatments, such as dulaglutide, protect the kidneys and may prevent serious complications even in individuals who are at stage 3 or 4 chronic kidney disease.”4

Dulaglutide was first approved by the US Food and Drug Administration in 2014 for the treatment of adults with type 2 diabetes as an adjunct therapy to diet and exercise. The treatment was approved in weekly 0.75 and 1.5-mg doses.5

—Christina Vogt

References:

  1. Gerstein HC, Colhoun HM, Dagenais GR, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial [Published online June 9, 2019]. Lancet. https://doi.org/10.1016/S0140-6736(19)31149-3.
  2. Dulaglutide reduces cardiovascular disease in people with type 2 diabetes [press release]. San Francisco, CA. American Diabetes Association. http://www.diabetes.org/newsroom/press-releases/2019/dulaglutide-reduces.html. June 9, 2019. Accessed June 11, 2019.
  3. Tuttle KR, Rayner B, Lakshmanan M, et al. Chronic kidney disease (CKD) outcomes with dulaglutide (DU) vs. insulin glargine (IG) in type 2 diabetes (T2D) and moderate-to-severe CKD by albuminuria status: AWARD-7. Diabetes. 2019;68(suppl. 1). https://doi.org/10.2337/db19-233-OR.
  4. Dulaglutide is safe and effective for people with type 2 diabetes and moderate to severe chronic kidney disease [press release]. San Francisco, CA. American Diabetes Association. http://www.diabetes.org/newsroom/press-releases/2019/dulaglutide-is-safe-and.html. June 10, 2019. Accessed June 11, 2019.
  5. FDA approves Trulicity™ (dulaglutide), Lilly's once-weekly therapy for adults with type 2 diabetes [press release]. Indianapolis, IN. Eli Lilly and Company. September 18, 2014. Accessed June 11, 2019.