Long-Acting Injectable GLP-1 Receptor Agonists for the Treatment of Adults with Type 2 Diabetes: Perspectives from Clinical Practice

Mario Luca Morieri, Angelo Avogaro, Gian Paolo Fadini Department of Medicine, University of Padova, Padova 35128, ItalyCorrespondence: Mario Luca MorieriDepartment of Medicine, University of Padova, Via Giustiniani 2, Padova 35128, ItalyTel +39 049 8217094Email morieri.mL@gmail.comAbstract: Randomiz...

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Autores principales:	Morieri ML, Avogaro A, Fadini GP
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	observational studies real-world evidence effectiveness cardiovascular prevention head-to-head comparisons innovative Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/dc598af776a743eeb3d537f5ebd78e23
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spelling	oai:doaj.org-article:dc598af776a743eeb3d537f5ebd78e232021-12-02T15:17:25ZLong-Acting Injectable GLP-1 Receptor Agonists for the Treatment of Adults with Type 2 Diabetes: Perspectives from Clinical Practice1178-7007https://doaj.org/article/dc598af776a743eeb3d537f5ebd78e232020-11-01T00:00:00Zhttps://www.dovepress.com/long-acting-injectable-glp-1-receptor-agonists-for-the-treatment-of-ad-peer-reviewed-article-DMSOhttps://doaj.org/toc/1178-7007Mario Luca Morieri, Angelo Avogaro, Gian Paolo Fadini Department of Medicine, University of Padova, Padova 35128, ItalyCorrespondence: Mario Luca MorieriDepartment of Medicine, University of Padova, Via Giustiniani 2, Padova 35128, ItalyTel +39 049 8217094Email morieri.mL@gmail.comAbstract: Randomized controlled trials (RCTs) have consistently shown glycemic and extra-glycemic benefits of long-acting injectable glucagon-like-peptide-1 receptor agonists (GLP-1RAs, liraglutide, albiglutide, exenatide once-weekly, dulaglutide, and semaglutide) in terms of reduction in the rates of cardiovascular events and mortality among patients with type 2 diabetes. Recently, the analyses of large datasets collecting routinely-accumulated data from clinical practice (ie, real-world studies, RWS) have provided new opportunities to complement the information obtained from RCTs. In this narrative review, we addressed clinically relevant questions that might be answered by well-conducted RWS: are subjects treated with GLP-1RAs in the “real-world” similar to those included in RCTs? Is the performance of GLP-1RA observed in the RWS (effectiveness) similar to that described in RCTs (efficacy)? Is the effectiveness similar in population of patients generally under-represented in RCTs? Are the cardiovascular benefits of GLP-1RAs confirmed in RWS? We also describe a few comparisons currently un-explored by specific RCTs, such as direct comparison between different administration strategies (eg, fixed- versus flexible-combination with basal-insulin) or between GLP-1RAs versus dipeptidyl-peptidase-4 inhibitor (DDP4i) or versus sodium/glucose cotransporter-2 inhibitors (SGLT-2i) on hard cardio-renal outcomes. Altogether, RWS provide highly informative information on treatment with GLP-1RAs. On the one side, RWS showed different clinical characteristics between subjects enrolled in RCTs versus those attending real-world clinics and receiving a GLP-1RA. On the other hand, RWS showed that GLP-1RA effectiveness is overall consistent in subgroups of patients less represented in RCTs. In addition, RWS allowed the identification of modifiable factors (eg, titration or adherence) that might guide physicians towards better GLP-1RAs use. Finally, multiple RWS reported better cardio-renal outcomes with GLP-1RAs than with DPP-4i, while initial findings from RWS described a weaker cardiovascular protection compared to SGLT-2i. Therefore, there is the need for further RWS and RCTs comparing these different classes of glucose lowering medications.Keywords: observational studies, real-world evidence, effectiveness, cardiovascular prevention, head-to-head comparisons, innovativeMorieri MLAvogaro AFadini GPDove Medical Pressarticleobservational studiesreal-world evidenceeffectivenesscardiovascular preventionhead-to-head comparisonsinnovativeSpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol Volume 13, Pp 4221-4234 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	observational studies real-world evidence effectiveness cardiovascular prevention head-to-head comparisons innovative Specialties of internal medicine RC581-951
spellingShingle	observational studies real-world evidence effectiveness cardiovascular prevention head-to-head comparisons innovative Specialties of internal medicine RC581-951 Morieri ML Avogaro A Fadini GP Long-Acting Injectable GLP-1 Receptor Agonists for the Treatment of Adults with Type 2 Diabetes: Perspectives from Clinical Practice
description	Mario Luca Morieri, Angelo Avogaro, Gian Paolo Fadini Department of Medicine, University of Padova, Padova 35128, ItalyCorrespondence: Mario Luca MorieriDepartment of Medicine, University of Padova, Via Giustiniani 2, Padova 35128, ItalyTel +39 049 8217094Email morieri.mL@gmail.comAbstract: Randomized controlled trials (RCTs) have consistently shown glycemic and extra-glycemic benefits of long-acting injectable glucagon-like-peptide-1 receptor agonists (GLP-1RAs, liraglutide, albiglutide, exenatide once-weekly, dulaglutide, and semaglutide) in terms of reduction in the rates of cardiovascular events and mortality among patients with type 2 diabetes. Recently, the analyses of large datasets collecting routinely-accumulated data from clinical practice (ie, real-world studies, RWS) have provided new opportunities to complement the information obtained from RCTs. In this narrative review, we addressed clinically relevant questions that might be answered by well-conducted RWS: are subjects treated with GLP-1RAs in the “real-world” similar to those included in RCTs? Is the performance of GLP-1RA observed in the RWS (effectiveness) similar to that described in RCTs (efficacy)? Is the effectiveness similar in population of patients generally under-represented in RCTs? Are the cardiovascular benefits of GLP-1RAs confirmed in RWS? We also describe a few comparisons currently un-explored by specific RCTs, such as direct comparison between different administration strategies (eg, fixed- versus flexible-combination with basal-insulin) or between GLP-1RAs versus dipeptidyl-peptidase-4 inhibitor (DDP4i) or versus sodium/glucose cotransporter-2 inhibitors (SGLT-2i) on hard cardio-renal outcomes. Altogether, RWS provide highly informative information on treatment with GLP-1RAs. On the one side, RWS showed different clinical characteristics between subjects enrolled in RCTs versus those attending real-world clinics and receiving a GLP-1RA. On the other hand, RWS showed that GLP-1RA effectiveness is overall consistent in subgroups of patients less represented in RCTs. In addition, RWS allowed the identification of modifiable factors (eg, titration or adherence) that might guide physicians towards better GLP-1RAs use. Finally, multiple RWS reported better cardio-renal outcomes with GLP-1RAs than with DPP-4i, while initial findings from RWS described a weaker cardiovascular protection compared to SGLT-2i. Therefore, there is the need for further RWS and RCTs comparing these different classes of glucose lowering medications.Keywords: observational studies, real-world evidence, effectiveness, cardiovascular prevention, head-to-head comparisons, innovative
format	article
author	Morieri ML Avogaro A Fadini GP
author_facet	Morieri ML Avogaro A Fadini GP
author_sort	Morieri ML
title	Long-Acting Injectable GLP-1 Receptor Agonists for the Treatment of Adults with Type 2 Diabetes: Perspectives from Clinical Practice
title_short	Long-Acting Injectable GLP-1 Receptor Agonists for the Treatment of Adults with Type 2 Diabetes: Perspectives from Clinical Practice
title_full	Long-Acting Injectable GLP-1 Receptor Agonists for the Treatment of Adults with Type 2 Diabetes: Perspectives from Clinical Practice
title_fullStr	Long-Acting Injectable GLP-1 Receptor Agonists for the Treatment of Adults with Type 2 Diabetes: Perspectives from Clinical Practice
title_full_unstemmed	Long-Acting Injectable GLP-1 Receptor Agonists for the Treatment of Adults with Type 2 Diabetes: Perspectives from Clinical Practice
title_sort	long-acting injectable glp-1 receptor agonists for the treatment of adults with type 2 diabetes: perspectives from clinical practice
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/dc598af776a743eeb3d537f5ebd78e23
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Long-Acting Injectable GLP-1 Receptor Agonists for the Treatment of Adults with Type 2 Diabetes: Perspectives from Clinical Practice

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