GLP-1 RAs Benefit Kidney Transplant Recipients With T2D

TOPLINE:

Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) could offer a treatment option for kidney transplant recipients with type 2 diabetes (T2D) because the medications were found to be linked to better graft and patient survival. Nonetheless, their use may heighten the risk for diabetic retinopathy, necessitating careful monitoring of patients.

METHODOLOGY:

• Given that diabetic nephropathy is the primary cause of kidney transplants in high-income countries leading to various cardiometabolic complications, GLP-1 RAs may benefit kidney transplant recipients because of their cardiometabolic and renal benefits.
• Researchers conducted a retrospective cohort study from January 2src13 to December 2src2src which included 18,src16 kidney transplant recipients with T2D at transplantation and Medicare as their primary insurance payer, of whom 1969 had at least one GLP-1 RA prescription filled posttransplant.
• They matched each GLP-1 RA user with a kidney transplant recipient who had not started a GLP-1 RA, was alive with a functioning graft, and had accrued identical posttransplant survival time.
• The outcomes assessed were death-censored graft loss and mortality.

TAKEAWAY:

• The median time from transplant to GLP-1 RA initiation was 19 months; dulaglutide was the most commonly prescribed GLP-1 RA.
• The 5-year unadjusted cumulative incidence of death-censored graft loss was 6.src% for GLP-1 RA users vs 1src.7% for nonusers (Gray’s test, P=.srcsrc4).
• Patients who used GLP-1 RAs had a 49% lower incidence of death-censored graft loss (adjusted subhazard ratio, src.51; P <.srcsrcsrc1) and a 31% lower risk for mortality (adjusted hazard ratio [aHR], src.69; P=.srcsrc1) than those who did not.
• Safety endpoints were rare and not linked to GLP-1 RA use, except for diabetic retinopathy (aHR, 1.49; P=.srcsrc8).

IN PRACTICE:

“Our findings also show that while the benefits of GLP-1 drugs are significant, their use does come with some added risk of diabetic retinopathy, suggesting that physicians need to carefully monitor the eye health of kidney transplant recipients with diabetes who are started on these drugs,” one of the study authors wrote in a press release.

SOURCE:

This study was led by Babak J. Orandi, MD, PhD, Departments of Surgery and Medicine, and Yusi Chen, MHS, Department of Surgery, both at New York University, New York City. It was published online on in The Lancet Diabetes & Endocrinology.

LIMITATIONS:

Despite the inverse probability of treatment weighting, residual confounding could not be ruled out. This study was limited to Medicare beneficiaries, which may have affected generalizability of the findings. The follow-up might have been insufficient to determine the true risk for medullary thyroid cancer, a known side effect of GLP-1 RAs.

DISCLOSURES:

This study was supported by grants from the National Institute on Aging, National Institute of Diabetes and Digestive and Kidney Diseases, and National Institute of Allergy and Infectious Diseases. One author reported being a senior scientist of the Scientific Registry of Transplant Recipients. Some authors reported serving on advisory boards; receiving speaker fees, consulting fees, research funding, and honoraria; and having other ties with many pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.