Liraglutide Improves Renal Outcomes in Type 2 Diabetes Patients With CV Risk

The study finds that the GLP-1 receptor agonist can slow progression of kidney disease, one of the most costly and debilitating complications of type 2 diabetes.

Patients with type 2 diabetes (T2D) and cardiovascular (CV) risk who took liraglutide, sold by Novo Nordisk as VIctoza, were less likely to progress to diabetic kidney disease than those taking placebo alongside usual care, according to results just published in the New England Journal of Medicine.

The secondary analysis from the LEADER trial finds that these high-risk patients were 22% less likely to reach a composite renal endpoint that included new onset macroalbuminuria, persistent doubling of the serum creatinine level, end-stage renal disease or death from renal disease.

There were 9340 patients in the study, with a median follow-up of 3.84 years. Renal outcomes occurred in 268 of the 4668 patients in the liraglutide group, compared with 337 of the 4672 patients in the placebo group. The results were primarily because patients taking liraglutide were less likely to develop persistent macroalbuminuria: 161 vs 215 patients. Rates of renal adverse events were similar between the 2 groups (15.1 for liraglutide vs 16.5 for placebo, per 1000 patient-years).

Kidney disease is one of the most costly and debilitating complications of long-term diabetes. A 2013 report found that Medicare spent $31 billion on end-stage renal disease, which did not include the $50 billion on chronic kidney disease. Besides liraglutide, therapies in another relatively new T2D class, the sodium-glucose co-transporter-2 (SGLT2) inhibitors, have been shown to slow progression to renal disease. More trial results that focus specifically on renal outcomes are expected for the SGLT2 class.

The findings come a few days after the FDA gave liraglutide a new indication that the drug can prevent CV events and death. Regulators acted based on results presented in June 2016 that showed the drug, a glucagon-like peptide-1 (GLP-1) receptor agonist, reduced CV events 13% and CV deaths by 22%. Liraglutide is only the second T2D drug and the first GLP-1 to get this indication from FDA.

Reference

Mann JFE, Orsted DD, Brown-Frandsen KB, et al. Liraglutide and renal outcomes in type 2 diabetes. N Engl J Med. 2017; 377:839-848. DOI: 10.1056/NEJMoa1616011