A RECENT cohort study has highlighted the potential of tirzepatide to significantly improve clinical outcomes in patients with Type 2 diabetes, particularly in comparison to the commonly used glucagon-like peptide 1 receptor agonists (GLP-1 RAs).
Cardiovascular events and kidney disease are common complications of diabetes, contributing substantially to morbidity and mortality. GLP-1 RAs used in the treatment of diabetes have been found to improve cardiovascular and kidney function. Tirzepatide is a dual GLP-1 and glucose-dependent insulinotropic polypeptide receptor agonist, which previous research has shown to improve cardiovascular and kidney metabolic measurements more significantly than classical GLP-1 RAs. Researchers wanted to understand the impact of tirzepatide on all-cause mortality and adverse cardiovascular or kidney events in Type 2 diabetes patients compared to standard GLP-1 RAs.
The study, involving over 140,000 patients from the US Collaborative Network of TriNetX, was conducted between June 2022–June 2023. The retrospective analysis included adults with Type 2 diabetes who had initiated treatment with either tirzepatide or a GLP-1 RA. Participants were excluded if they had Stage 5 chronic kidney disease, kidney failure, or a recent history of myocardial infarction or stroke at baseline. The study’s primary objective was to compare the effects of the two treatments on all-cause mortality, while secondary outcomes included major adverse cardiovascular events (MACEs), kidney events, and acute kidney injury.
Among the 14,834 patients treated with tirzepatide, the risk of death was reduced by 42% compared to those on GLP-1 RAs. Specifically, the adjusted hazard ratio for all-cause mortality in the tirzepatide group was 0.58, indicating a significant survival benefit. Additionally, tirzepatide was associated with a 20% reduction in the risk of MACEs, a 24% reduction in the combined risk of MACEs and mortality, a 48% reduction in kidney events, and a 22% reduction in acute kidney injury. The treatment also led to more significant decreases in glycated haemoglobin and body weight compared to GLP-1 RAs, further underscoring its potential advantages.
The study authors concluded that the findings suggest that tirzepatide may offer enhanced protection against all-cause mortality and major cardiovascular and kidney events, reinforcing its role as a promising treatment option for this patient population. These findings could influence clinical practice, suggesting that tirzepatide may become a preferred treatment option for Type 2 diabetes, particularly for patients at higher risk of cardiovascular and renal complications.
Laith Gergi, EMJ
Reference
Chuang MH et al. Clinical outcomes of tirzepatide or GLP-1 receptor agonists in individuals with type 2 diabetes. JAMA Netw Open. 2024;7(8):e2427258-.
