Some newer diabetes drugs may help decrease risk of COPD exacerbation

Glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT-2) inhibitors were associated with fewer severe chronic obstructive pulmonary disease (COPD) exacerbations in patients with type 2 diabetes versus sulfonylureas, a recent study found.

Researchers in the United Kingdom performed a population-based cohort study using primary care and hospital databases to evaluate whether GLP-1 receptor agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, or SGLT-2 inhibitors were associated with lower risk for COPD exacerbations in patients with COPD and type 2 diabetes. The study included three active comparator cohorts of patients who had a history of COPD and were starting the study drugs or sulfonylureas for the first time. Cox proportional hazards models with propensity-score fine stratification weighting were used to estimate hazard ratios for severe COPD exacerbations, defined as exacerbations requiring hospital admission, and moderate COPD exacerbations, defined as coprescription of an oral corticosteroid and an antibiotic in conjunction with an outpatient COPD diagnosis on the same day. The study results were published Nov. 1 by BMJ.

Overall, 1,252 patients starting GLP-1 receptor agonists and 14,259 starting sulfonylureas were included in the first cohort, 8,731 patients starting DPP-4 inhibitors and 18,204 starting sulfonylureas were included in the second cohort, and 2,956 patients starting SGLT-2 inhibitors and 10,841 starting sulfonylureas were included in the third cohort. Each cohort was followed for a median of approximately one year. Compared with sulfonylureas, GLP-1 receptor agonists were associated with a lower risk for severe and moderate exacerbations (hazard ratios [HRs], 0.70 [95% CI, 0.49 to 0.99] and 0.63 [95% CI, 0.43 to 0.94], respectively), SGLT-2 inhibitors were associated with a lower risk for severe but not moderate exacerbations (HRs, 0.62 [95% CI, 0.48 to 0.81] and 1.02 [95% CI, 0.83 to 1.27]), and DPP-4 inhibitors were associated with a modestly lower incidence of severe and moderate exacerbations (hazard ratio, 0.91 [95% CI, 0.82 to 1.02] and 0.93 [95% CI, 0.82 to 1.07]), with CIs including the null value.

The researchers noted that the primary care database used for the study does not include information on medication adherence and that residual confounding is possible, among other limitations. They concluded that GLP-1 receptor agonists and SGLT-2 inhibitors were associated with reduced risk for severe COPD exacerbations versus sulfonylureas in patients with type 2 diabetes and COPD, while no clear association with reduced risk was seen with DPP-4 inhibitors. “Further research, including confirmatory randomised controlled trials, will be needed to investigate the potential of GLP-1 receptor agonists and SGLT-2 inhibitors as a therapeutic option in patients with type 2 diabetes and chronic obstructive pulmonary disease,” the authors wrote.