Adding Exenatide to Glucose-Lowering Regimens Reduces Heart Failure Risk

San Diego—A retrospective analysis of an electronic medical record database found that patients with type 2 diabetes who were receiving a glucose-lowering therapy and then added twice-daily injections of exenatide to their regimen had an association with a reduced risk of developing heart failure. Results 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 US Food and Drug Administration approval to treat type 2 diabetes. Exenatide is not recommended to replace insulin therapy and is not intended to use with insulin, according to a news release from the drug’s manufacturers (Amylin Pharmaceuticals and Eli Lilly and Co). In this study, the authors analyzed data from the national Medical Quality Improvement Consortium of >14,000 healthcare providers that use GE Healthcare’s Centricity electronic medical record. They identified 778,408 patients with type 2 diabetes who had received glucose-lowering treatment (exenatide, insulin, and/or another therapy) between January 1, 2005, and September 30, 2010. The authors randomly matched patients who took exenatide on a 1:1 basis with patients who did not take exenatide based on sex, 10-year age band, follow-up time, and use of thiazolidinediones. They defined heart failure as patients who had a clinical diagnosis of heart failure as well as elevated (>100 pg/mL) brain natriuretic peptide concentrations. In an analysis of 50,330 patients adjusting for the weighted Charlson Comorbidity Index (CCI) to adjust for disease severity, those who took exenatide with insulin and another therapy were 57% less likely to develop heart failure compared with those who took insulin and another therapy (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.35-0.53). When not adjusting for the weighted CCI, the OR was 0.41 with a 95% CI of 0.34 to 0.51. In an analysis of 53,446 patients adjusting for the weighted CCI, those who received exenatide and other noninsulin therapies were 31% less likely to develop heart failure compared with a group that only took other noninsulin therapies (OR, 0.69; 95% CI, 0.44-1.07). When not adjusting for the weighted CCI, the OR and 95% CI were the same as when the authors adjusted for the weighted CCI. When combining all of the patients (n=103,776), those who took exenatide were 54% less likely to develop heart failure compared with those who did not take exenatide (OR, 0.46; 95% CI, 0.38-0.56). In the poster, 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.