American Diabetes Association (ADA) 71st Scientific Sessions: Page 6 of 6

August 12, 2011

Adding Exenatide to Glucose-Lowering Regimens Reduces Heart Failure Risk

A retrospective analysis of data from an electronic medical records database found that adding twice-daily injections of exenatide to a glucose-lowering regimen for patients with type 2 diabetes was associated with a reduced risk of heart failure. Results of the analysis were presented at the ADA meeting in a poster titled The Risk of Heart Failure among Patients Receiving Exenatide Versus Other Glucose-Lowering Medications for Type 2 Diabetes: A Matched Retrospective Cohort Analysis of the GE Healthcare Electronic Medical Record Database.

In 2005, exenatide became the first glucagon-like, peptide-1 receptor to receive FDA approval as a treatment for patients with type 2 diabetes. Exenatide is not recommended to be used as a replacement for insulin therapy nor is it intended to be  used with insulin, according to a news release from the manufacturers of the antidiabetic drug (Amylin Pharmaceuticals and Eli Lilly and Co).

Study investigators analyzed data obtained from the national Medical Quality Improvement Consortium, which consists of more than 14,000 healthcare providers that use GE Healthcare’s Centricity electronic medical records system. They identified 778,408 patients with a diagnosis of type 2 diabetes who had received glucose-lowering treatment (ie, exenatide, insulin, and/or another therapy) between January 2005 and September 2010.

The authors randomly matched the patients who took exenatide 1:1 with those who had not taken the drug, pairing them based on sex, age (according to 10-year spans), follow-up time available, and thiazolidinedione use. Patients were considered to have experienced heart failure if they had documented evidence of having had elevated concentrations (>100 pg/mL) of brain natriuretic peptide in addition to a clinical diagnosis of heart failure.

In an analysis of 50,330 patients, with disease severity adjusted according to the weighted Charlson Comorbidity Index (CCI), those who took exenatide with insulin and another antidiabetic therapy were 57% less likely to develop heart failure than those who took insulin and another antidiabetic therapy, but who had not used exenatide (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.35-0.53). When not adjusting for disease severity according to the weighted CCI, the OR dropped to 0.41 (95% CI, 0.34-0.51).

In an analysis of 53,446 patients, again after adjusting for disease severity using the weighted CCI, those individuals who received exenatide and other noninsulin therapies were 31% less likely to develop heart failure compared with those who took other noninsulin therapies but had not taken exenatide (OR, 0.69; 95% CI, 0.44-1.07). The unadjusted OR and 95% CI were identical to the adjusted findings.

When combining data for all the patients (n = 103,776) with type 2 diabetes, the patients who took exenatide were 54% less likely to develop heart failure compared with those who had not received exenatide (OR, 0.46; 95% CI, 0.38-0.56). The authors noted that the results of the study were “consistent with the positive effects of exenatide on cardiovascular risk factors observed in the clinical development program for exenatide and in clinical practice.” 

This analysis was funded by Amylin Pharmaceuticals, Inc, and Eli Lilly and Co.