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Liu Y, Nie D, Lou X. The Cardiovascular Benefits of Glucagon-Like Peptide-1 Receptor Agonists as Novel Diabetes Drugs Are Mediated via the Suppression of miR-203a-3p and miR-429 Expression. DNA Cell Biol 2024; 43:387-394. [PMID: 38923881 DOI: 10.1089/dna.2024.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Abstract
Coronary artery disease (CAD) is associated with a high fatality rate and a heavy global health care burden. Glucagon-like peptide-1 (GLP-1) exerts positive cardiovascular effects, although the molecular mechanisms are unclear. Therefore, this study aimed to verify whether the cardioprotective effects of GLP-1 are mediated through the regulation of micro-RNA (miRNA) expression. Follow-up assessments were conducted for 116 patients with type 2 diabetes mellitus (T2DM) alone (controls) and 123 patients with both T2DM and CAD. After matching, each group comprised 63 patients, and age, body mass index, and serum levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), triglycerides (TG), and hemoglobin A1C (HbA1c) were compared. Subsequently, the expression profiles of four circulating miRNAs (miR-203a-3p, miR-429, miR-205-5p, and miR-203b-5p) were assessed via quantitative reverse transcription real-time polymerase chain reaction in the 63 patients with diabetes and CAD between 6 months (baseline) and 12 months after the initiation of GLP-1 receptor (GLP-1R) therapy. As expected, the metabolic factors were significantly improved after 6 months of treatment with GLP-1R compared with pre-treatment values, and the expression levels of two of the miRNAs (miR-203a-3p and miR-429) decreased from baseline levels in those with diabetes and CAD. The results suggest that the cardiovascular benefits induced by GLP-1R are mediated via suppressed expression of two miRNAs: miR-203a-3p and miR-429.
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Affiliation(s)
| | | | - Xueyong Lou
- Department of Endocrinology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
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Vemulapalli HS, Vajje J, Rehman W, Virk GS, Shah K, Chaudhari SS, Mian IUD, Saleem F. Safety and Efficacy of Liraglutide on Cardiovascular Outcomes in Patients With Diabetes Mellitus: A Meta-Analysis of Randomized Controlled Trials. Cureus 2023; 15:e45421. [PMID: 37854744 PMCID: PMC10581595 DOI: 10.7759/cureus.45421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 10/20/2023] Open
Abstract
Diabetes mellitus (DM) is a chronic metabolic disorder, with type 2 diabetes (T2DM) significantly impacting the cardiovascular (CV) system. Our comprehensive study on the cardiovascular effects of liraglutide, conducted concurrently with the formulation of diabetes treatment guidelines, aims to provide healthcare providers and patients with reassurance regarding the safety and effectiveness of liraglutide. From the beginning until August 20, 2023, we conducted searches in databases including PubMed, Web of Science, Embase, Cochrane Library, Scopus, and Google Scholar. These searches aimed to identify studies comparing liraglutide to control in terms of symptom resolution among patients with T2DM. For all relevant outcomes, we calculated risk ratios along with their corresponding 95% confidence intervals. Thirteen randomized controlled trials (RCTs) were included in this analysis. The results demonstrated a significant reduction in the risk of major adverse cardiovascular events (MACE), myocardial infarction, CV mortality, and all-cause mortality. No significant difference was found between the liraglutide and control groups for the outcome of stroke. However, sensitivity analysis revealed a significant reduction in the risk of stroke among patients taking liraglutide. Our comprehensive meta-analysis strongly supports the use of liraglutide for managing cardiovascular disease (CVD) due to its established safety and effectiveness. Further RCTs and meta-analyses are needed to more thoroughly evaluate liraglutide's therapeutic potential, with the aim of enhancing the quality of life for those with CVD.
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Affiliation(s)
| | - Jaahnavi Vajje
- Internal Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, IND
| | - Wajeeh Rehman
- Internal Medicine, United Health Services Hospitals, State University of New York Upstate Medical University Binghamton Campus, Johnson City, USA
| | - Ghazala S Virk
- Internal Medicine, Avalon University School of Medicine, Ohio, USA
| | - Krushi Shah
- Internal Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College, Gandhinagar, IND
| | - Sandipkumar S Chaudhari
- General Physician, Lions General Hospital, Mehsana, IND
- General Practice, General Hospital, Vadnagar, IND
| | - Irfan-Ud-Din Mian
- Medicine, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Faraz Saleem
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
- Internal Medicine, Akhtar Saeed Medical and Dental College, Lahore, PAK
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Deerochanawong C, Krittayaphong R, Romano JGU, Rhee NA, Permsuwan U. Cost-Utility of Liraglutide Plus Standard of Care Versus Standard of Care in People with Type 2 Diabetes and Cardiovascular Risk in Thailand. Diabetes Ther 2023; 14:531-552. [PMID: 36719606 PMCID: PMC9981833 DOI: 10.1007/s13300-023-01371-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/16/2023] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Liraglutide has demonstrated a significant reduction in the primary major composite cardiovascular (CV) outcome (CV death, non-fatal myocardial infarction, non-fatal stroke). This study aimed to determine the cost-utility of adding liraglutide to the standard of care (SoC) for treating type 2 diabetes (T2D) in Thailand for three cohorts: people with atherosclerotic cardiovascular disease (ASCVD), with no ASCVD, and all people with T2D. METHODS A Markov model was developed to capture the long-term costs and outcomes under the perspective of the healthcare system. Costs were based on local data, the transitional probabilities were derived from the LEADER trial, and utilities were derived from published studies. Future costs and outcomes were discounted at 3% annually. A series of sensitivity analyses were performed. RESULTS Compared to SoC, adding liraglutide incurred higher costs and gained more quality-adjusted life-years (QALYs), yielding incremental cost-effectiveness ratios (ICERs) of above 1 million Thai baht (THB) for the three cohorts. The most influential parameter was the discount rate. When the annual cost of liraglutide reduced from 87,874 to 30,340 THB, 30,116 THB, and 31,617 THB for all people with T2D, people with ASCVD, and people without ASCVD, respectively, the ICER fell below the local threshold of 160,000 THB/QALY. Compared to the SoC treatment, the liraglutide group acquired more clinical benefit in terms of fewer CVD. Sensitivity analyses revealed that with an increase in the level of willingness-to-pay (WTP) threshold, adding liraglutide had an increased chance of being a cost-effective strategy. CONCLUSION Compared to the SoC treatment, adding liraglutide at the current cost is not cost-effective at the local WTP. People with T2D with ASCVD would have the most potential gain from adding liraglutide treatment compared to other populations.
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Affiliation(s)
- Chaicharn Deerochanawong
- College of Medicine, Ministry of Public Health, Rajavithi Hospital, Rangsit University, Bangkok, 10400, Thailand
| | - Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Unchalee Permsuwan
- Center for Medical and Health Technology Assessment (CM-HTA), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand.
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, 239 Huaykaew Road, Suthep, Chiang Mai, 50200, Thailand.
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Side effect profile of pharmacologic therapies for liver fibrosis in nonalcoholic fatty liver disease: a systematic review and network meta-analysis. Eur J Gastroenterol Hepatol 2023; 35:1-14. [PMID: 36468565 DOI: 10.1097/meg.0000000000002471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Several studies have found that antifibrosis treatment for nonalcoholic fatty liver disease (NAFLD) can cause a variety of side effects. No network meta-analysis (NMA) analyzes the adverse events of antifibrotic drugs for NAFLD. This NMA aimed to systematically compare the drug-related side effects when using different pharmacological agents for the treatment of liver fibrosis in NAFLD. PubMed, EMBASE, Web of Science and Cochrane Library were systematically searched to select related studies published in English from the database inception until 30 June 2022. We conducted Bayesian fixed-effects NMA using data from randomized controlled trials (RCTs) to derive relative risks (RRs). The surface under the cumulative ranking (SUCRA) probabilities was used to assess ranking. A total of 26 RCTs with 19 interventions met the inclusion criteria. SUCRA analysis suggested that the lanifibranor group had the highest risk of diarrhea (SUCRA, 94), whereas the liraglutide group had the highest risk of constipation (SUCRA, 92.9). The semaglutide group showed the highest incidence of nausea (SUCRA, 81.2) and abdominal pain (SUCRA, 90.5), respectively. The cenicriviroc group showed the highest risk in the incidence of fatigue (SUCRA, 82.4). The MSDC-0602K group had the highest risk of headache (SUCRA, 76.4), whereas the obeticholic acid group had the highest risk of pruritus (SUCRA, 80.1). The risk of side effects significantly varied among different pharmacologic regimens, and evidence showed that lanifibranor, liraglutide, semaglutide, cenicriviroc, MSDC-0602K and obeticholic acid were the pharmacological interventions with the highest risk in patients with NAFLD. This study may guide clinicians and support further research.
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Durak A, Akkus E, Canpolat AG, Tuncay E, Corapcioglu D, Turan B. Glucagon-like peptide-1 receptor agonist treatment of high carbohydrate intake-induced metabolic syndrome provides pleiotropic effects on cardiac dysfunction through alleviations in electrical and intracellular Ca 2+ abnormalities and mitochondrial dysfunction. Clin Exp Pharmacol Physiol 2021; 49:46-59. [PMID: 34519087 DOI: 10.1111/1440-1681.13590] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 02/06/2023]
Abstract
The pleiotropic effects of glucagon-like peptide-1 receptor (GLP-1R) agonists on the heart have been recognised in obese or diabetic patients. However, little is known regarding the molecular mechanisms of these agonists in cardioprotective actions under metabolic disturbances. We evaluated the effects of GLP-1R agonist liraglutide treatment on left ventricular cardiomyocytes from high-carbohydrate induced metabolic syndrome rats (MetS rats), characterised with insulin resistance and cardiac dysfunction with a long-QT. Liraglutide (0.3 mg/kg for 4 weeks) treatment of MetS rats significantly reversed long-QT, through a shortening the prolonged action potential duration and recovering inhibited K+ -currents. We also determined a significant recovery in the leaky sarcoplasmic reticulum (SR) and high cytosolic Ca2+ -level, which are confirmed with a full recovery in activated Na+ /Ca2+ -exchanger currents (INCX ). Moreover, the liraglutide treatment significantly reversed the depolarised mitochondrial membrane potential (MMP), increased production of oxidant markers, and cellular acidification together with the depressed ATP production. Our light microscopy analysis of isolated cardiomyocytes showed marked recoveries in the liraglutide-treated MetS group such as marked reverses in highly dilated T-tubules and SR-mitochondria junctions. Moreover, we determined a significant increase in depressed GLUT4 protein level in liraglutide-treated MetS group, possibly associated with recovery in casein kinase 2α. Overall, the study demonstrated a molecular mechanism of liraglutide-induced cardioprotection in MetS rats, at most, via its pleiotropic effects, such as alleviation in the electrical abnormalities, Ca2+ -homeostasis, and mitochondrial dysfunction in ventricular cardiomyocytes.
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Affiliation(s)
- Aysegul Durak
- Faculty of Medicine, Department of Biophysics, Ankara University, Ankara, Turkey
| | - Erman Akkus
- Faculty of Medicine, Department of Internal Medicine, Ankara University, Ankara, Turkey
| | - Asena Gokcay Canpolat
- Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara University, Ankara, Turkey
| | - Erkan Tuncay
- Faculty of Medicine, Department of Biophysics, Ankara University, Ankara, Turkey
| | - Demet Corapcioglu
- Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara University, Ankara, Turkey
| | - Belma Turan
- Faculty of Medicine, Department of Biophysics, Ankara University, Ankara, Turkey.,Faculty of Medicine, Department of Biophysics, Lokman Hekim University, Ankara, Turkey
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Seo YG. Side Effects Associated with Liraglutide Treatment for Obesity as Well as Diabetes. J Obes Metab Syndr 2021; 30:12-19. [PMID: 33071241 PMCID: PMC8017323 DOI: 10.7570/jomes20059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/25/2020] [Accepted: 08/02/2020] [Indexed: 02/06/2023] Open
Abstract
Liraglutide is a glucagon-like peptide-1 receptor agonist used as a treatment for type 2 diabetes mellitus, which has been expanded for use at a higher dose in weight control. Therefore, it is necessary to consider adverse reactions of the drug at high doses as well as at lower doses after the indication has been expanded. Body mass index criteria for patients prescribed the drug in the real world tend to be applied less rigorously, which may increase the number of adverse reactions due to over-prescription. Liraglutide treatment was found effective and safe in some studies, while others have warned about its risks. Therefore, this review summarizes the current data available on side effects associated with liraglutide.
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Affiliation(s)
- Young-Gyun Seo
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
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7
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Muzurović E, Mikhailidis DP. Impact of glucagon-like peptide 1 receptor agonists and sodium-glucose transport protein 2 inhibitors on blood pressure and lipid profile. Expert Opin Pharmacother 2020; 21:2125-2135. [DOI: 10.1080/14656566.2020.1795132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Emir Muzurović
- Department of Internal Medicine, Endocrinology Section, Clinical Center of Montenegro, Podgorica, Montenegro
- University of Montenegro Faculty of Medicine, Podgorica, Montenegro
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
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Xing Y, Chen J, Zhao L, Ma H. Analysis of the effect of liraglutide on glycemic variability in patients with type 2 diabetes. Endocr J 2020; 67:455-468. [PMID: 31996492 DOI: 10.1507/endocrj.ej19-0530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The efficacy of liraglutide in the treatment of glycemic variability in type 2 diabetic patients remains to be fully elucidated. Some studies evaluated the efficacy and safety of liraglutide in glycemic variability, and this meta-analysis was performed to evaluate the accuracy of the results of existing studies on the efficacy of liraglutide. We conducted a comprehensive search for all relevant studies published in PubMed, EMBASE, Cochrane Library, and China Academic Journal Full-Text Database from the beginning of 2011 to October 31, 2019. The mean ± SD and 95% confidence interval were used for evaluation, and subgroup and sensitivity analysis were carried out. Publication bias was estimated by funnel plots and Egger's tests. A total of 16 studies were included in the meta-analysis involving 492 participants. MAGE (mean amplitude of glycemic excursion), LAGE (largest amplitude of glycemic excursions), SD (standard deviation of blood glucose), and MODD (mean of daily differences) were collected to reflect the variability of blood glucose. The glycemic variability indexes of patients before and after treatment with liraglutide were compared. Patients with treatment had lower glycemic variability compared with patients receiving treatment of liraglutide. Compared with the patients before the treatment, the patients after the treatment had a smaller glycemic variability (MAGE: I2 = 92%, p < 0.01, Z = 11.91, p < 0.01, MD = -2.78, 95%CI: -3.24 - -2.32; LAGE: I2 = 76%, p = 0.08, Z = 9.94, p < 0.01, MD = -2.20, 95%CI: -2.59 - -1.81; MODD: I2 = 74%, p = 0.002, Z = 14.03, p < 0.01, MD = -0.90, 95%CI: -1.02 - -0.77; SD: I2 = 93%, p < 0.01, Z = 3.62, p < 0.01, SMD = -1.77, 95%CI: -2.73 - -0.81). Sensitivity analysis showed that our results were reliable and no evidence of significant publication bias was detected. The results of this study suggest that patients with type 2 diabetes treated with liraglutide are associated with lower glycemic variability.
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Affiliation(s)
- Yuling Xing
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang 050017, China
- Graduate School of Hebei Medical University, Shijiazhuang 050017, China
| | - Jinhu Chen
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang 050017, China
| | - Liying Zhao
- Graduate School of Hebei Medical University, Shijiazhuang 050017, China
| | - Huijuan Ma
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang 050017, China
- Hebei Key Laboratory of Metabolic Diseases, Hebei General Hospital Shijiazhuang, Hebei 050051, China
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei 050017, China
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Grabarczyk TR, Wissman NK. Weight Outcomes With Empagliflozin as Compared With Liraglutide in Veterans With Type 2 Diabetes Mellitus. Ann Pharmacother 2020; 54:981-987. [PMID: 32274930 DOI: 10.1177/1060028020915791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Glucagon-like peptide-1 agonists and sodium glucose cotransporter 2 inhibitors are associated with weight loss and improved cardiovascular outcomes, and are increasingly used in pharmacotherapy for type 2 diabetes mellitus (T2DM). OBJECTIVES To compare weight loss outcomes of empagliflozin and liraglutide in patients with T2DM and overweight/obesity not yet prescribed insulin but requiring additional pharmacotherapy to improve glycemic control. METHODS This is an observational, multisite, cohort study of veterans with T2DM prescribed liraglutide or empagliflozin. Participants were prescribed either empagliflozin or liraglutide prior to November 1, 2017, had a hemoglobin A1C (A1C) ≥7.0%, had a body mass index ≥27 kg/m2, and were not treated with insulin at baseline. The primary outcome was change in weight after 1 year using multiple regression. Secondary outcomes were the proportion achieving ≥5% weight loss and change in A1C. RESULTS Weight loss was not significantly different between groups: -2.17 kg (95% CI: -2.91 to -1.42) in the liraglutide group (n = 298) and -2.81 kg (95% CI: -3.43 to -2.20) in the empagliflozin group (n = 247; P > 0.05). After adjusting for covariates, this effect remained nonsignificant. There was no difference in change in A1C between liraglutide (-0.83%; 95% CI: -1.05% to -0.62%) and empagliflozin (-0.71%; 95% CI: -0.89% to -0.53%; P > 0.05). CONCLUSIONS AND RELEVANCE There was no significant difference in weight outcomes after 1 year in veterans treated with liraglutide versus empagliflozin. Because both medications did show modest weight loss, both remain good options for patients needing an additional medication to improve glycemic control that is at least weight neutral.
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10
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Duan CM, Wan TF, Wang Y, Yang QW. Cardiovascular outcomes of liraglutide in patients with type 2 diabetes: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17860. [PMID: 31725627 PMCID: PMC6867782 DOI: 10.1097/md.0000000000017860] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Liraglutide is a novel, long-acting glucagon-like peptide-1 (GLP-1) analogue used to treat type 2 diabetes mellitus. However, the cardiovascular safety and benefits of liraglutide treatment on type 2 diabetes patients remain in debate. In this study, we aimed to examine the overall cardiovascular outcomes of liraglutide in patients with type 2 diabetes. METHODS In this systematic review and meta-analysis, we searched the PubMed, Embase, and Web of Knowledge databases up to September 1st, 2017 for randomized trials in which type 2 diabetes patients were assigned to liraglutide and placebo or other comparators groups. RESULTS Eight studies fulfilled the eligibility criteria for inclusion and 14,608 patients were analyzed in this systematic review and meta-analysis. We found patients in the liraglutide group had a lower risk of major cardiovascular events (MACE) (RR = 0.89, 95% CI: 0.82-0.96, P = .002), acute myocardial infarction (AMI) (RR = 0.85, 95% CI: 0.74-0.99, P = .036), all-cause death (RR = 0.84, 95% CI: 0.74-0.96, P = .009), and cardiovascular death (RR = 0.77, 95% CI: 0.65-0.91, P = .002) than all comparator groups. However, liraglutide treatment did not decrease incidence of stroke (RR = 0.86, 95% CI: 0.70-1.04, P = .124). But among the MACE subgroups analysis, a significant reduction of MACE with liraglutide was only observed in placebo-controlled trials (RR = 0.89, 95% CI: 0.83-0.96, P = .004) but not in studies concerning other comparators (RR = 0.58, 95% CI: 0.29-1.16, P = .122). CONCLUSIONS In conclusion, our results suggest that liraglutide treatment decreases the risk of MACE, AMI, all-cause death and cardiovascular death among patients with type 2 diabetes.
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Affiliation(s)
- Chun-Mei Duan
- Department of Neurology, Xinqiao Hospital, The Third Military Medical University, Chongqing
| | - Teng-Fei Wan
- Department of First Cadre Ward, The General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Yue Wang
- Department of Neurology, Xinqiao Hospital, The Third Military Medical University, Chongqing
| | - Qing-Wu Yang
- Department of Neurology, Xinqiao Hospital, The Third Military Medical University, Chongqing
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Nerup N, Ambrus R, Lindhe J, Achiam MP, Jeppesen PB, Svendsen LB. The effect of glucagon‐like peptide‐1 and glucagon‐like peptide‐2 on microcirculation: A systematic review. Microcirculation 2019; 26:e12367. [DOI: 10.1111/micc.12367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/28/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Nikolaj Nerup
- Department of Surgical GastroenterologyRigshospitaletCopenhagen University Hospital Copenhagen Ø Denmark
| | - Rikard Ambrus
- Department of Surgical GastroenterologyRigshospitaletCopenhagen University Hospital Copenhagen Ø Denmark
| | - Joanna Lindhe
- Department of Surgical GastroenterologyRigshospitaletCopenhagen University Hospital Copenhagen Ø Denmark
| | - Michael P. Achiam
- Department of Surgical GastroenterologyRigshospitaletCopenhagen University Hospital Copenhagen Ø Denmark
| | - Palle B. Jeppesen
- Department of Medical GastroenterologyRigshospitaletCopenhagen University Hospital Copenhagen Ø Denmark
| | - Lars B. Svendsen
- Department of Surgical GastroenterologyRigshospitaletCopenhagen University Hospital Copenhagen Ø Denmark
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12
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Albarkah YA, Tourkmani AM, Bin Rsheed AM, Al Harbi TJ, Ebeid YA, Bushnag RA. Effects of liraglutide addition to multiple diabetes regimens on weight and risk of hypoglycemia for a cohort with type 2 diabetes followed in primary care clinics in Saudi Arabia. J Family Med Prim Care 2019; 8:1919-1924. [PMID: 31334156 PMCID: PMC6618200 DOI: 10.4103/jfmpc.jfmpc_372_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Context: Available therapies for type 2 diabetes mellitus (T2DM) do not adequately control glycemia in the long term as they do not address the issue of declining beta cell function and do not impact positively on weight or cardiovascular concerns associated with the disease. Aims: To measure changes in hemoglobin A1c, weight, and hypoglycemia after the addition of liraglutide to 3 therapeutic regimens of patients with T2DM. Settings and Design: An observational cohort study that was implemented in Al-Wazarat Health Center in Riyadh, Saudi Arabia. Methods and Materials: The study included 38 T2DM patients who were screened for initiation of liraglutide in combination with their treatment regimens; sulphonylurea, sulphonylurea with basal insulin (glargine), and multiple daily injections of insulin. The cohort was followed for 12 months, and the liraglutide was started with 0.6 mg dose that escalated to 1.2 and 1.8 mg. Glycemic level and weight were measured 3 times, whereas hypoglycemia was measured 2 times. Statistical Analysis Used: Quantitative continuous paired data were compared using a paired t-test and the nonparametric Wilcoxon signed rank test. Results: There was a statistically significant reduction of hemoglobin A1c with 1.2 mg dose (mean difference = 0.84%, P = 0.003). There were no statistically significant differences regarding the effect of liraglutide in addition to the 3 treatment regimens on patients’ weight (P = 0.08, 0.472, 0.08, respectively). Regarding hypoglycemia, liraglutide has showed minimal effect. Conclusions: Sustained effect of liraglutide on glycemic control in patients with T2DM without any major hypoglycemic episodes.
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Affiliation(s)
- Yasser A Albarkah
- Department of Pharmaceutical Care, Medical Services Directorate, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.,Family and Community Medicine, Chronic Diseases Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ayla M Tourkmani
- Department of Pharmaceutical Care, Medical Services Directorate, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz M Bin Rsheed
- Department of Pharmaceutical Care, Medical Services Directorate, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Turki J Al Harbi
- Department of Pharmaceutical Care, Medical Services Directorate, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Yasser A Ebeid
- Department of Pharmaceutical Care, Medical Services Directorate, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Reuof A Bushnag
- Department of Pharmaceutical Care, Medical Services Directorate, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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13
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Wägner AM, Miranda-Calderín G, Ugarte-Lopetegui MA, Marrero-Santiago H, Suárez-Castellano L, López-Madrazo MJ, Alberiche-Ruano MP, Abselam Ahmed N, Alemán C, Castellot-Martín A, Díez Del Pino A, Nóvoa-Mogollón FJ. Effect of liraglutide on physical performance in type 2 diabetes: Results of a randomized, double-blind, controlled trial (LIPER2). DIABETES & METABOLISM 2018; 45:268-275. [PMID: 30223083 DOI: 10.1016/j.diabet.2018.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 07/31/2018] [Accepted: 08/23/2018] [Indexed: 02/06/2023]
Abstract
AIMS To assess the effect of the GLP-1 analogue liraglutide on measures of cardiac function and physical performance in patients with type 2 diabetes (T2D). METHODS In this phase-IV randomized double-blind placebo-controlled parallel-group clinical trial at a tertiary hospital, T2D patients with HbA1c levels of 7-10% with oral agents and/or intermediate-/long-acting insulin were allocated (computer-generated randomization, ratio 1:1) to either liraglutide 1.8 mg/day or a placebo for 6 months. The primary endpoint was maximum oxygen consumption (VO2max) during cycle ergometry, while other procedures included a 6-min walk test, echocardiography, anthropometry and blood tests. Safety endpoints were also monitored, and an intention-to-treat analysis was performed. RESULTS A total of 24 patients (15 women) aged 52 (11.7) years, with diabetes duration of 8.7 (5.8) years, BMI 34.98 (6.2) kg/m2 and HbA1c 8.2% (0.68%), were randomized to liraglutide 1.8 mg daily or placebo. There were no differences in VO2max [17.98 (4.8) vs. 15.90 (4.96) mL/kg/min; P > 0.10], VE/VCO2 slope [30.18 (4.8) vs. 32 (4.49)], left ventricular ejection fraction or 6-min walk test [530.7 (86) vs. 503.9 (84) m] at 6 months. HbA1c was lower (6.7% vs. 7.7%; P = 0.005), with a trend towards lower maximum systolic blood pressure during ergometry [171.7 (24.4) vs. 192.5 (25.6); P = 0.052] in the liraglutide group at the end of the study. There were no severe adverse events. CONCLUSION In this trial, liraglutide improved glycaemic control in T2D, but had no significant effects on either physical performance or myocardial function.
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Affiliation(s)
- A M Wägner
- Materno-Infantil de Gran Canaria, Av Marítima s/n, 35016 Las Palmas de Gran Canaria, Spain; Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - G Miranda-Calderín
- Physical Medicine and Rehabilitation Department, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Av Marítima s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - M A Ugarte-Lopetegui
- Physical Medicine and Rehabilitation Department, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Av Marítima s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - H Marrero-Santiago
- Cardiology Department, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Av Marítima s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - L Suárez-Castellano
- Cardiology Department, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Av Marítima s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - M J López-Madrazo
- Materno-Infantil de Gran Canaria, Av Marítima s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - M P Alberiche-Ruano
- Materno-Infantil de Gran Canaria, Av Marítima s/n, 35016 Las Palmas de Gran Canaria, Spain; Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - N Abselam Ahmed
- Physical Medicine and Rehabilitation Department, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Av Marítima s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - C Alemán
- Physical Medicine and Rehabilitation Department, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Av Marítima s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - A Castellot-Martín
- Gastroenterology Department, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Av Marítima s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - A Díez Del Pino
- Hospital Pharmacy, Complejo Hospitalario Universitario Insular Materno-Infantil de Gran Canaria, Av Marítima s/n, 35016 Las Palmas de Gran Canaria, Spain
| | - F J Nóvoa-Mogollón
- Materno-Infantil de Gran Canaria, Av Marítima s/n, 35016 Las Palmas de Gran Canaria, Spain; Instituto Universitario de Investigaciones Biomédicas y Sanitarias (IUIBS), Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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14
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Kelly EM, Cutlip DE. Diabetes Drugs and Cardiovascular Event Reduction: A Paradigm Shift. US CARDIOLOGY REVIEW 2018. [DOI: 10.15420/usc.2017:35:1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This review article summarizes the recent cardiovascular outcome data for sodium–glucose cotransporter-2 inhibitors and glucagon-like peptide-1 analogues, which have been found to reduce cardiovascular events. We also detail the implications these new medications will have on clinical practice through a review of recent diabetes guidelines and cost-effectiveness data.
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15
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Lambadiari V, Pavlidis G, Kousathana F, Varoudi M, Vlastos D, Maratou E, Georgiou D, Andreadou I, Parissis J, Triantafyllidi H, Lekakis J, Iliodromitis E, Dimitriadis G, Ikonomidis I. Effects of 6-month treatment with the glucagon like peptide-1 analogue liraglutide on arterial stiffness, left ventricular myocardial deformation and oxidative stress in subjects with newly diagnosed type 2 diabetes. Cardiovasc Diabetol 2018; 17:8. [PMID: 29310645 PMCID: PMC5759220 DOI: 10.1186/s12933-017-0646-z] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/23/2017] [Indexed: 01/04/2023] Open
Abstract
Background Incretin-based therapies are used in the treatment of type 2 diabetes mellitus (T2DM) and obesity. We investigated the changes in arterial stiffness and left ventricular (LV) myocardial deformation after 6-month treatment with the GLP-1 analogue liraglutide in subjects with newly diagnosed T2DM. Methods We randomized 60 patients with newly diagnosed and treatment-naive T2DM to receive either liraglutide (n = 30) or metformin (n = 30) for 6 months. We measured at baseline and after 6-month treatment: (a) carotid-femoral pulse wave velocity (PWV) (b) LV longitudinal strain (GLS), and strain rate (GLSR), peak twisting (pTw), peak twisting velocity (pTwVel) and peak untwisting velocity (pUtwVel) using speckle tracking echocardiography. LV untwisting was calculated as the percentage difference between peak twisting and untwisting at MVO (%dpTw–UtwMVO), at peak (%dpTw–UtwPEF) and end of early LV diastolic filling (%dpTw–UtwEDF) (c) Flow mediated dilatation (FMD) of the brachial artery and percentage difference of FMD (FMD%) (d) malondialdehyde (MDA), protein carbonyls (PCs) and NT-proBNP. Results After 6-months treatment, subjects that received liraglutide presented with a reduced PWV (11.8 ± 2.5 vs. 10.3 ± 3.3 m/s), MDA (0.92 [0.45–2.45] vs. 0.68 [0.43–2.08] nM/L) and NT-proBNP (p < 0.05) in parallel with an increase in GLS (− 15.4 ± 3 vs. − 16.6 ± 2.7), GLSR (0.77 ± 0.2 vs. 0.89 ± 0.2), pUtwVel (− 97 ± 49 vs. − 112 ± 52°, p < 0.05), %dpTw–UtwMVO (31 ± 10 vs. 40 ± 14), %dpTw–UtwPEF (43 ± 19 vs. 53 ± 22) and FMD% (8.9 ± 3 vs. 13.2 ± 6, p < 0.01). There were no statistically significant differences of the measured markers in subjects that received metformin except for an improvement in FMD. In all subjects, PCs levels at baseline were negatively related to the difference of GLS (r = − 0.53) post-treatment and the difference of MDA was associated with the difference of PWV (r = 0.52) (p < 0.05 for all associations) after 6-month treatment. Conclusions Six-month treatment with liraglutide improves arterial stiffness, LV myocardial strain, LV twisting and untwisting and NT-proBNP by reducing oxidative stress in subjects with newly diagnosed T2DM. ClinicalTrials.gov Identifier NCT03010683
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Affiliation(s)
- Vaia Lambadiari
- 2nd Department of Internal Medicine, Research Unit and Diabetes Center, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Rimini 1, Haidari, 12462, Athens, Greece.
| | - George Pavlidis
- 2nd Department of Internal Medicine, Research Unit and Diabetes Center, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Rimini 1, Haidari, 12462, Athens, Greece
| | - Foteini Kousathana
- 2nd Department of Internal Medicine, Research Unit and Diabetes Center, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Rimini 1, Haidari, 12462, Athens, Greece
| | - Maria Varoudi
- 2nd Cardiology Department, Attikon Hospital, National and Kapodistrian University of Athens, Medical School, Rimini 1 str, Haidari, 12462, Athens, Greece
| | - Dimitrios Vlastos
- 2nd Cardiology Department, Attikon Hospital, National and Kapodistrian University of Athens, Medical School, Rimini 1 str, Haidari, 12462, Athens, Greece
| | - Eirini Maratou
- Hellenic National Center for the Prevention of Diabetes and Its Complications HNDC, 3 Ploutarchou str, 10675, Athens, Greece
| | - Dimitrios Georgiou
- Department of Pharmaceutical Chemistry, School of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Andreadou
- Department of Pharmaceutical Chemistry, School of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
| | - John Parissis
- 2nd Cardiology Department, Attikon Hospital, National and Kapodistrian University of Athens, Medical School, Rimini 1 str, Haidari, 12462, Athens, Greece
| | - Helen Triantafyllidi
- 2nd Cardiology Department, Attikon Hospital, National and Kapodistrian University of Athens, Medical School, Rimini 1 str, Haidari, 12462, Athens, Greece
| | - John Lekakis
- 2nd Cardiology Department, Attikon Hospital, National and Kapodistrian University of Athens, Medical School, Rimini 1 str, Haidari, 12462, Athens, Greece
| | - Efstathios Iliodromitis
- 2nd Cardiology Department, Attikon Hospital, National and Kapodistrian University of Athens, Medical School, Rimini 1 str, Haidari, 12462, Athens, Greece
| | - George Dimitriadis
- 2nd Department of Internal Medicine, Research Unit and Diabetes Center, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Rimini 1, Haidari, 12462, Athens, Greece
| | - Ignatios Ikonomidis
- 2nd Cardiology Department, Attikon Hospital, National and Kapodistrian University of Athens, Medical School, Rimini 1 str, Haidari, 12462, Athens, Greece
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16
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Bouchi R, Nakano Y, Fukuda T, Takeuchi T, Murakami M, Minami I, Izumiyama H, Hashimoto K, Yoshimoto T, Ogawa Y. Reduction of visceral fat by liraglutide is associated with ameliorations of hepatic steatosis, albuminuria, and micro-inflammation in type 2 diabetic patients with insulin treatment: a randomized control trial. Endocr J 2017; 64:269-281. [PMID: 27916783 DOI: 10.1507/endocrj.ej16-0449] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Liraglutide, an analogue of human glucagon-like peptide 1, reduces cardiovascular events in patients with type 2 diabetes; however, it has still been unknown by which mechanisms liraglutide could reduce cardiovascular events. Type 2 diabetic patients with insulin treatment were enrolled in this randomized, open-label, comparative study. Participants were randomly assigned to liraglutide plus insulin (liraglutide group) and insulin treatment (control group) at 1:1 allocation. Primary endpoint was the change in viscera fat are (VFA, cm2) at 24 weeks. Liver attenuation index (LAI) measured by abdominal computed tomography, urinary albumin-to-creatinine ratio (ACR, mg/g), and C-reactive protein (CRP) levels, skeletal muscle index (SMI), and quality of life (QOL) related to diabetes treatment were also determined. Seventeen patients (8; liraglutide group, 9; control group, mean age 59 ± 13 years; 53% female) completed this study. Liraglutide treatment significantly reduced VFA at 24 weeks; whereas, SFA was unchanged. ACR, LAI, and CRP levels were significantly reduced by liraglutide at 24 weeks and there was no difference in SMI between the two groups. Changes in VFA from baseline to 24 weeks were significantly associated with those in LAI, albuminuria, and HbA1c. Liraglutide treatment significantly improved QOL scores associated with anxiety and dissatisfaction with treatment and satisfaction with treatment. No severe adverse events were observed in both groups. Our data suggest that liraglutide could reduce visceral adiposity in parallel with attenuation of hepatic fat accumulation, albuminuria and micro-inflammation and improve QOL related to diabetes care in insulin-treated patients with type 2 diabetes.
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Affiliation(s)
- Ryotaro Bouchi
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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17
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Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JFE, Nauck MA, Nissen SE, Pocock S, Poulter NR, Ravn LS, Steinberg WM, Stockner M, Zinman B, Bergenstal RM, Buse JB. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2016; 375:311-22. [PMID: 27295427 PMCID: PMC4985288 DOI: 10.1056/nejmoa1603827] [Citation(s) in RCA: 4464] [Impact Index Per Article: 558.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The cardiovascular effect of liraglutide, a glucagon-like peptide 1 analogue, when added to standard care in patients with type 2 diabetes, remains unknown. METHODS In this double-blind trial, we randomly assigned patients with type 2 diabetes and high cardiovascular risk to receive liraglutide or placebo. The primary composite outcome in the time-to-event analysis was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The primary hypothesis was that liraglutide would be noninferior to placebo with regard to the primary outcome, with a margin of 1.30 for the upper boundary of the 95% confidence interval of the hazard ratio. No adjustments for multiplicity were performed for the prespecified exploratory outcomes. RESULTS A total of 9340 patients underwent randomization. The median follow-up was 3.8 years. The primary outcome occurred in significantly fewer patients in the liraglutide group (608 of 4668 patients [13.0%]) than in the placebo group (694 of 4672 [14.9%]) (hazard ratio, 0.87; 95% confidence interval [CI], 0.78 to 0.97; P<0.001 for noninferiority; P=0.01 for superiority). Fewer patients died from cardiovascular causes in the liraglutide group (219 patients [4.7%]) than in the placebo group (278 [6.0%]) (hazard ratio, 0.78; 95% CI, 0.66 to 0.93; P=0.007). The rate of death from any cause was lower in the liraglutide group (381 patients [8.2%]) than in the placebo group (447 [9.6%]) (hazard ratio, 0.85; 95% CI, 0.74 to 0.97; P=0.02). The rates of nonfatal myocardial infarction, nonfatal stroke, and hospitalization for heart failure were nonsignificantly lower in the liraglutide group than in the placebo group. The most common adverse events leading to the discontinuation of liraglutide were gastrointestinal events. The incidence of pancreatitis was nonsignificantly lower in the liraglutide group than in the placebo group. CONCLUSIONS In the time-to-event analysis, the rate of the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke among patients with type 2 diabetes mellitus was lower with liraglutide than with placebo. (Funded by Novo Nordisk and the National Institutes of Health; LEADER ClinicalTrials.gov number, NCT01179048.).
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Affiliation(s)
- Steven P Marso
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Gilbert H Daniels
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Kirstine Brown-Frandsen
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Peter Kristensen
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Johannes F E Mann
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Michael A Nauck
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Steven E Nissen
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Stuart Pocock
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Neil R Poulter
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Lasse S Ravn
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - William M Steinberg
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Mette Stockner
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Bernard Zinman
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Richard M Bergenstal
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - John B Buse
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
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Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JFE, Nauck MA, Nissen SE, Pocock S, Poulter NR, Ravn LS, Steinberg WM, Stockner M, Zinman B, Bergenstal RM, Buse JB. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2016. [PMID: 27295427 DOI: 10.1056/nejmoa1603827}] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The cardiovascular effect of liraglutide, a glucagon-like peptide 1 analogue, when added to standard care in patients with type 2 diabetes, remains unknown. METHODS In this double-blind trial, we randomly assigned patients with type 2 diabetes and high cardiovascular risk to receive liraglutide or placebo. The primary composite outcome in the time-to-event analysis was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The primary hypothesis was that liraglutide would be noninferior to placebo with regard to the primary outcome, with a margin of 1.30 for the upper boundary of the 95% confidence interval of the hazard ratio. No adjustments for multiplicity were performed for the prespecified exploratory outcomes. RESULTS A total of 9340 patients underwent randomization. The median follow-up was 3.8 years. The primary outcome occurred in significantly fewer patients in the liraglutide group (608 of 4668 patients [13.0%]) than in the placebo group (694 of 4672 [14.9%]) (hazard ratio, 0.87; 95% confidence interval [CI], 0.78 to 0.97; P<0.001 for noninferiority; P=0.01 for superiority). Fewer patients died from cardiovascular causes in the liraglutide group (219 patients [4.7%]) than in the placebo group (278 [6.0%]) (hazard ratio, 0.78; 95% CI, 0.66 to 0.93; P=0.007). The rate of death from any cause was lower in the liraglutide group (381 patients [8.2%]) than in the placebo group (447 [9.6%]) (hazard ratio, 0.85; 95% CI, 0.74 to 0.97; P=0.02). The rates of nonfatal myocardial infarction, nonfatal stroke, and hospitalization for heart failure were nonsignificantly lower in the liraglutide group than in the placebo group. The most common adverse events leading to the discontinuation of liraglutide were gastrointestinal events. The incidence of pancreatitis was nonsignificantly lower in the liraglutide group than in the placebo group. CONCLUSIONS In the time-to-event analysis, the rate of the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke among patients with type 2 diabetes mellitus was lower with liraglutide than with placebo. (Funded by Novo Nordisk and the National Institutes of Health; LEADER ClinicalTrials.gov number, NCT01179048.).
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Affiliation(s)
- Steven P Marso
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Gilbert H Daniels
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Kirstine Brown-Frandsen
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Peter Kristensen
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Johannes F E Mann
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Michael A Nauck
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Steven E Nissen
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Stuart Pocock
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Neil R Poulter
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Lasse S Ravn
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - William M Steinberg
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Mette Stockner
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Bernard Zinman
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - Richard M Bergenstal
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
| | - John B Buse
- From the University of Texas Southwestern Medical Center, Dallas (S.P.M.); Massachusetts General Hospital, Boston (G.H.D.); Novo Nordisk, Bagsvaerd, Denmark (K.B.-F., P.K., L.S.R., M.S.); Friedrich Alexander University of Erlangen, Erlangen (J.F.E.M.), and St. Josef Hospital, Ruhr University, Bochum (M.A.N.) - both in Germany; Cleveland Clinic, Cleveland (S.E.N.); London School of Hygiene and Tropical Medicine Medical Statistics Unit (S.P.) and Imperial College London (N.R.P.), London; George Washington University Medical Center, Washington, DC (W.M.S.); Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto (B.Z.); International Diabetes Center at Park Nicollet, Minneapolis (R.M.B.); and the University of North Carolina School of Medicine, Chapel Hill (J.B.B.)
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Niafar M, Pourafkari L, Porhomayon J, Nader N. A systematic review of GLP-1 agonists on the metabolic syndrome in women with polycystic ovaries. Arch Gynecol Obstet 2015; 293:509-15. [DOI: 10.1007/s00404-015-3976-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/24/2015] [Indexed: 01/21/2023]
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Howland RH. Melatonin, Liraglutide, and Naltrexone/Bupropion for the Treatment of Obesity and Medication-Related Weight Gain. J Psychosoc Nurs Ment Health Serv 2015; 53:19-22. [DOI: 10.3928/02793695-20150526-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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