RCTs and real-life studies have shown the efficacy of GLP-1 RAs on weight loss, glycemic outcomes, and prevention of cardiovascular (CV) events, but long-term data are lacking. This was a retrospective cohort study of 253 patients with a first prescription of a GLP-1 RA between 2009 and 2016 and a minimum follow-up of 5 years. The endpoints of the study were weight and glycemic outcomes. Secondary endpoints were the occurrence of renal and CV events, comparing patients with GLP-1 RA treatment durations over 5 years and under 5 years. Median follow-up was 8.15 years (5.01 to 11.74 years). Mean duration of GLP-1 treatment was 5.4 years (SD 3.2). The mean proportion of follow-up time on GLP-1 RA treatment was 69.6%. The proportion of patients still taking the GLP-1 RA was 85.1% at 1 year, 76.7% at 2 years, 64.1% at 4 years, 56.9% at 6 years, 57.7% at 8 years, and 56.3% at 10 years. Younger age at baseline, higher baseline HbA1c, and being hospitalized for heart failure were associated with a shorter time to GLP-1 RA discontinuation. Switching from any other GLP-1 RA to dulaglutide or semaglutide, and greater decreases in HbA1c at 1 and 2 years were associated to longer time to treatment discontinuation. Comparing patients who had withdrawn GLP-1 RA therapy and those with ongoing GLP-1 RA at each time point, there were significant differences in mean HbA1c (7.81% vs 7.16% at 6 years, 8.08% vs 6.85% at 8 years, 8.26% vs 6.69% at 10 years respectively), and mean weight loss (-1.4 vs -5.6 kg at 6 years, -1.0 vs -6.8 kg at 8 years respectively), except for mean weight loss at 10 years. In the shorter treatment duration group (<5 years on GLP-1) there was a higher proportion of strokes/transient ischemic attacks (7.5% vs 1.3% in the group treated for over 5 years, P=0.014). Acute coronary syndromes were more frequent in the shorter treatment duration group, although not statistically significantly (6.5% vs 3.8% respectively, P=0.37). No differences in arterial revascularization procedures, no differences in renal outcomes or hospitalizations for heart failure were observed. There were no deaths for CV causes. The study showed that GLP-1 RA treatment maintains its favorable effects on HbA1c and weight over time. The reduction in atherosclerotic events, mainly driven by stroke protection, is consistent with RCT studies and therefore reinforces the long-term use of these antidiabetic medications in real life.
21 May 2022 - 24 May 2022