A LARGE comparative effectiveness study has found that sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are associated with a lower risk of chronic obstructive pulmonary disease (COPD) exacerbations in patients with Type 2 diabetes (T2D) and active COPD compared with dipeptidyl peptidase-4 inhibitors (DPP-4is).
The study analysed data from three major USA insurance claims databases between 2013–2023. Using a propensity score–matched cohort design, researchers compared COPD exacerbation risk among patients aged 40 years or older who initiated treatment with SGLT-2is versus DPP-4is, GLP-1RAs versus DPP-4is, and SGLT-2is versus GLP-1RAs. COPD exacerbations were defined as outpatient visits requiring oral glucocorticoids or hospitalisation for COPD. Hazard ratios (HRs) and incidence rate differences (IRDs) per 100 person-years (PYs) were calculated to assess risk reduction across the three treatment groups.
Among 393,847 patients, the matched cohorts included 27,991 pairs in the SGLT-2i versus DPP-4i comparison, 32,107 pairs in the GLP-1RA versus DPP-4i comparison, and 36,218 pairs in the SGLT-2i versus GLP-1RA comparison. Over a median follow-up of 145 days, SGLT-2is were associated with a lower risk of COPD exacerbation compared to DPP-4is (9.26 versus 11.4 per 100 PYs; HR: 0.81, 95% CI: 0.76–0.86; IRD: −2.20, 95% CI: −2.83 to −1.58). GLP-1RAs were also linked to a lower exacerbation risk than DPP-4is (9.89 versus 11.49 per 100 PYs; HR: 0.86, 95% CI: 0.81–0.91; IRD: −1.60, 95% CI: −2.18 to −1.02). The difference in exacerbation risk between SGLT-2is and GLP-1RAs was minimal (9.47 versus 10.00 per 100 PYs; HR: 0.94, 95% CI: 0.89–1.00; IRD: −0.55, 95% CI: −1.09 to −0.01). Results remained consistent across sensitivity and subgroup analyses.
These findings suggest that SGLT-2is and GLP-1RAs may be preferable to DPP-4is for patients with T2D and COPD, potentially guiding future treatment decisions in this population.
Ada Enesco, EMJ
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. 2025; DOI: 10.1001/jamainternmed.2024.7811.
