SODIUM-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) may significantly reduce the risk of chronic obstructive pulmonary disease (COPD) exacerbations in patients with type 2 diabetes (T2D), according to a large U.S.-based study. The study compared these medications with dipeptidyl peptidase-4 inhibitors (DPP-4is) in more than 393,000 patients and found that both SGLT-2is and GLP-1RAs were associated with fewer moderate to severe COPD flare-ups.
In this comparative effectiveness research, investigators used three large U.S. insurance claims databases to analyze adults aged 40 and older with T2D and active COPD. Researchers conducted three propensity score-matched cohort studies, comparing the risk of COPD exacerbations across different drug classes: SGLT-2is versus DPP-4is, GLP-1RAs versus DPP-4is, and SGLT-2is versus GLP-1RAs.
Patients on SGLT-2is and GLP-1RAs experienced fewer COPD exacerbations compared to those on DPP-4is:
– SGLT-2is vs DPP-4is: 2.2 fewer events per 100 person-years (HR, 0.81)
– GLP-1RAs vs DPP-4is: 1.6 fewer events per 100 person-years (HR, 0.86)
– SGLT-2is vs GLP-1RAs: Minimal difference in risk reduction
The study highlights that while both SGLT-2is and GLP-1RAs may offer advantages for patients with diabetes and COPD, the differences between these two drug classes were less pronounced compared to their benefits over DPP-4is. The findings may help guide prescribing decisions for patients with comorbid type 2 diabetes and COPD. While the study provides promising evidence, the authors note the observational nature of the data and caution that residual or unmeasured confounding factors cannot be excluded.
Reference: Ray A et al. Glucose-Lowering Medications and Risk of Chronic Obstructive Pulmonary Disease Exacerbations in Patients With Type 2 Diabetes. JAMA Intern Med. doi:10.1001/jamainternmed.2024.7811.
Anaya Malik | AMJ
