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format-standard has-post-thumbnail hentry category-diabetes-endocrinology category-pulmonology category-rheumatology"> <header class="entry-header"> <h1 class="entry-title textcenter-xs">GLP-1RA Use Linked to Reduced COPD Exacerbation Rates Compared With Other Diabetes Therapies</h1> <div class="entry-thumbnail"> <img width="300" height="225" src="https://www.brighamhealthonamission.org/wp-content/uploads/2024/07/ozempic-insulin-injectio.jpg" class="attachment-full size-full wp-post-image" alt="" decoding="async" fetchpriority="high" /> </div> </header> <div class="entry-content"> <p>Glucagon-like peptide 1 receptor agonists (GLP-1RA) are FDA-approved for treating type 2 diabetes (T2D), and in preclinical and clinical studies, they have also shown beneficial effects on the airway.</p> <p>Now, a team at Brigham and Women’s Hospital has reported that patients with T2D and chronic obstructive pulmonary disease (COPD) who initiate GLP-1RA have decreased risk of both moderate and severe COPD exacerbations, compared with users of sulfonylureas or dipeptidyl peptidase 4 inhibitors (DPP-4i). Users of GLP-1RA and sodium–glucose cotransporter 2 inhibitors (SGLT2i) had similar exacerbation outcomes.</p> <p><a title="Dinah Foer, MD, Profile" href="https://physiciandirectory.brighamandwomens.org/details/14363/dinah-foer-allergy_and_immunology-chestnut_hill?pk_vid=1b05ebaf4f6e03f0171944383211e9c4" target="_blank" rel="noopener noreferrer">Dinah Foer, MD</a>, an attending physician in the <a title="The Brigham Division of Allergy and Immunology" href="https://www.brighamandwomens.org/medicine/allergy-clinical-immunology" target="_blank" rel="noopener noreferrer">Division of Allergy and Immunology</a> at the Brigham, <a title="Elizabeth W. Karlson, MD, MS, Bio" href="https://www.massgeneralbrigham.org/en/research-and-innovation/centers-and-programs/personalized-medicine/about/staff" target="_blank" rel="noopener noreferrer">Elizabeth W. Karlson, MD, MS</a>, a rheumatologist and epidemiologist in the <a title="The Brigham Division of Rheumatology, Inflammation, and Immunity" href="https://www.brighamandwomens.org/medicine/rheumatology-inflammation-immunity" target="_blank" rel="noopener noreferrer">Division of Rheumatology, Inflammation, and Immunity</a> at the Brigham and vice-president of Personalized Medicine at Mass General Brigham, Zachary Strasser, MD, formerly of Massachusetts General Hospital, and colleagues detail the findings in the <a title="Association of GLP-1 Receptor Agonists with Chronic Obstructive Pulmonary Disease Exacerbations among Patients with Type 2 Diabetes" href="https://www.atsjournals.org/doi/abs/10.1164/rccm.202303-0491oc" target="_blank" rel="noopener noreferrer"><em>American Journal of Respiratory and Critical Care Medicine</em></a><em>.</em></p> <h2>Methods</h2> <p>The study was a retrospective analysis of the electronic health record system for Mass General Brigham. Using natural language processing, a form of artificial intelligence (AI), the researchers extracted key data (e.g., on smoking and pulmonary function testing) that identified 1,642 patients with COPD who received a new prescription for a diabetes drug between January 1, 2012, and May 27, 2022:</p> <ul> <li>Sulfonylurea users—701 (43% of the cohort)</li> <li>SGLT2i users—353 (21%)</li> <li>GLP-1RA users—328 (20%)</li> <li>DPP-4i users—260 (16%)</li> </ul> <h2>Primary Outcome</h2> <p>The primary outcome was the combined number of moderate and severe exacerbations during the six months after drug initiation. A severe exacerbation was defined as an inpatient encounter with a COPD code as the primary and/or principal diagnosis. A moderate exacerbation was defined as a prednisone prescription for COPD during the six-month period.</p> <p>In a multivariate model that considered demographic and clinical factors (the “clinical model”), exacerbation rates compared with GLP-1RA use were:</p> <ul> <li>Sulfonylurea use—Incidence rate ratio (IRR), 2.09 (P<0.0001)</li> <li>DPP-4i use—IRR, 1.48 (P=0.02)</li> <li>SGLT2i use—Rate not significantly elevated</li> </ul> <p>The researchers also used a “metabolic model” that added baseline BMI and baseline hemoglobin A1c to the clinical model. In those analyses, exacerbation rates were elevated only among sulfonylurea users (IRR, 1.97; P<0.0001) compared with GLP-1RA users.</p> <h2>Secondary Outcome</h2> <p>The secondary outcome was exacerbation risk, defined as days to COPD exacerbation from the date of drug initiation.</p> <p>In the clinical model, the risk of moderate exacerbation compared with GLP-1RA use was:</p> <ul> <li>Sulfonylurea use—HR, 2.09 (P<0.0001)</li> <li>DPP-4i use—HR, 1.52 (P=0.01)</li> <li>SGLT2i use—Risk not elevated</li> </ul> <p>The risk of severe exacerbation was:</p> <ul> <li>Sulfonylurea use—HR, 2.21 (P=0.0004)</li> <li>DPP-4i use—HR, 1.85 (P=0.02)</li> <li>SGLT2i use—Risk not elevated</li> </ul> <p>In the metabolic model, risk of moderate exacerbation remained increased only for sulfonylurea users (HR, 1.92; P<0.0001).</p> <p>The risk of severe exacerbation in the metabolic model was:</p> <ul> <li>DPP-4i use—HR, 2.04 (P=0.005)</li> <li>Sulfonylurea use—HR, 2.63 (P<0.0001)</li> <li>SGLT2i use—Risk not elevated</li> </ul> <h2>Implications for Personalized Medicine</h2> <p>If prospective studies support these findings, they could guide treatment choices for patients with comorbid COPD and T2D, analogous to the selection of GLP-1RA for patients with comorbid atherosclerotic cardiovascular disease or SGLT2i for those with comorbid heart failure.</p> <p>More broadly, the potential therapeutic relevance of metabolic pathways in COPD is intriguing, and further study is warranted to understand the mechanisms underlying the associations observed here.</p> <script async type="text/javascript" src="//tracking.skyword.com/tracker.js?contentId=281474980327614"></script> <div class="sharedaddy sd-sharing-enabled"><div class="robots-nocontent sd-block sd-social sd-social-icon sd-sharing"><h3 class="sd-title">Share this:</h3><div class="sd-content"><ul><li class="share-linkedin"><a rel="nofollow noopener noreferrer" data-shared="sharing-linkedin-7889" class="share-linkedin sd-button share-icon no-text" href="https://www.brighamhealthonamission.org/2024/07/24/glp-1ra-use-linked-to-reduced-copd-exacerbation-rates-compared-with-other-diabetes-therapies/?share=linkedin" target="_blank" title="Click to share on LinkedIn" ><span></span><span class="sharing-screen-reader-text">Click to share on LinkedIn (Opens in new window)</span></a></li><li class="share-twitter"><a rel="nofollow noopener noreferrer" data-shared="sharing-twitter-7889" class="share-twitter sd-button share-icon no-text" href="https://www.brighamhealthonamission.org/2024/07/24/glp-1ra-use-linked-to-reduced-copd-exacerbation-rates-compared-with-other-diabetes-therapies/?share=twitter" target="_blank" title="Click to share on Twitter" ><span></span><span class="sharing-screen-reader-text">Click to share on Twitter (Opens in new window)</span></a></li><li class="share-facebook"><a rel="nofollow noopener noreferrer" data-shared="sharing-facebook-7889" class="share-facebook sd-button share-icon no-text" href="https://www.brighamhealthonamission.org/2024/07/24/glp-1ra-use-linked-to-reduced-copd-exacerbation-rates-compared-with-other-diabetes-therapies/?share=facebook" target="_blank" title="Click to share on Facebook" ><span></span><span class="sharing-screen-reader-text">Click to share on Facebook (Opens in new window)</span></a></li><li class="share-print"><a rel="nofollow noopener noreferrer" data-shared="" class="share-print sd-button share-icon no-text" href="https://www.brighamhealthonamission.org/2024/07/24/glp-1ra-use-linked-to-reduced-copd-exacerbation-rates-compared-with-other-diabetes-therapies/#print" target="_blank" title="Click to print" ><span></span><span class="sharing-screen-reader-text">Click to print (Opens in new window)</span></a></li><li class="share-email"><a rel="nofollow noopener noreferrer" data-shared="" class="share-email sd-button share-icon no-text" href="mailto:?subject=%5BShared%20Post%5D%20GLP-1RA%20Use%20Linked%20to%20Reduced%20COPD%20Exacerbation%20Rates%20Compared%20With%20Other%20Diabetes%20Therapies&body=https%3A%2F%2Fwww.brighamhealthonamission.org%2F2024%2F07%2F24%2Fglp-1ra-use-linked-to-reduced-copd-exacerbation-rates-compared-with-other-diabetes-therapies%2F&share=email" target="_blank" title="Click to email a link to a friend" data-email-share-error-title="Do you have email set up?" data-email-share-error-text="If you're having problems sharing via email, you might not have email set up for your browser. 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