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BACKGROUND: In a randomized, controlled trial that compared liraglutide, a glucagon-like peptide 1 analogue, with placebo in patients with type 2 diabetes and high cardiovascular risk who were receiving usual care, we found that liraglutide resulted in lower risks of the primary end point (nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes) and death. However, the long-term effects of liraglutide on renal outcomes in patients with type 2 diabetes are unknown. METHODS: We report the prespecified secondary renal outcomes of that randomized, controlled trial in which patients were assigned to receive liraglutide or placebo. The secondary renal outcome was a composite of new-onset persistent macroalbuminuria, persistent doubling of the serum creatinine level, end-stage renal disease, or death due to renal disease. The risk of renal outcomes was determined with the use of time-to-event analyses with an intention-to-treat approach. Changes in the estimated glomerular filtration rate and albuminuria were also analyzed. RESULTS: A total of 9340 patients underwent randomization, and the median follow-up of the patients was 3.84 years. The renal outcome occurred in fewer participants in the liraglutide group than in the placebo group (268 of 4668 patients vs. 337 of 4672; hazard ratio, 0.78; 95% confidence interval [CI], 0.67 to 0.92; P=0.003). This result was driven primarily by the new onset of persistent macroalbuminuria, which occurred in fewer participants in the liraglutide group than in the placebo group (161 vs. 215 patients; hazard ratio, 0.74; 95% CI, 0.60 to 0.91; P=0.004). The rates of renal adverse events were similar in the liraglutide group and the placebo group (15.1 events and 16.5 events per 1000 patient-years), including the rate of acute kidney injury (7.1 and 6.2 events per 1000 patient-years, respectively). CONCLUSIONS: This prespecified secondary analysis shows that, when added to usual care, liraglutide resulted in lower rates of the development and progression of diabetic kidney disease than placebo. (Funded by Novo Nordisk and the National Institutes of Health; LEADER ClinicalTrials.gov number, NCT01179048 .).

Liraglutide and Renal Outcomes in Type 2 Diabetes / Mann, Jfe; Ørsted, Dd; Brown-Frandsen, K; Marso, Sp; Poulter, Nr; Rasmussen, S; Tornøe, K; Zinman, B; Buse, Jb; Bergenstal R, LEADER Steering Committee and Investigators.; Daniels, G; Moses, Ac; Nauck, M; Nissen, S; Pocock, S; Steinberg, W; Stockner, M; Kristensen, P; Ravn, Ls; Zychma, M; Flyvbjerg, A; Ford, I; Kloos, Rt; Schactman, Mj; Sleight, P; Swedberg, K; Tenner, Sm; Akalın, S; Arechavaleta, R; Bain, S; Babkowski, Mc; Benroubi, M; Berard, L; Comlekci, A; Czupryniak, L; Eliasson, B; Eriksson, M; Fonseca, V; Franek, E; Gross, J; Hafidh, K; Haluzik, M; Hayes, F; Huang, Yy; Jacob, S; Kaddaha, G; Khalil, A; Kilhovd, B; Laakso, M; Leiter, L; Lalic, N; Ji, L; Luedemann, J; Mannucci, E; Marre, M; Masmiquel, L; Mota, M; Omar, M; O’Shea, D; Pan, C; Petrie, J; Pieber, T; Pratley, R; Raz, I; Rea, R; Rutten, G; Satman, I; Shestakova, M; Simpson, R; Smith, D; Tack, C; Tarnow, L; Thomas, N; Van Gaal, L; Travert, F; Vidal, J; Warren, M; Yoon, Kh; 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[10.1056/NEJMoa1616011]

Liraglutide and Renal Outcomes in Type 2 Diabetes.

Gambineri A;Repaci A;Ribichini D;
2017

Abstract

BACKGROUND: In a randomized, controlled trial that compared liraglutide, a glucagon-like peptide 1 analogue, with placebo in patients with type 2 diabetes and high cardiovascular risk who were receiving usual care, we found that liraglutide resulted in lower risks of the primary end point (nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes) and death. However, the long-term effects of liraglutide on renal outcomes in patients with type 2 diabetes are unknown. METHODS: We report the prespecified secondary renal outcomes of that randomized, controlled trial in which patients were assigned to receive liraglutide or placebo. The secondary renal outcome was a composite of new-onset persistent macroalbuminuria, persistent doubling of the serum creatinine level, end-stage renal disease, or death due to renal disease. The risk of renal outcomes was determined with the use of time-to-event analyses with an intention-to-treat approach. Changes in the estimated glomerular filtration rate and albuminuria were also analyzed. RESULTS: A total of 9340 patients underwent randomization, and the median follow-up of the patients was 3.84 years. The renal outcome occurred in fewer participants in the liraglutide group than in the placebo group (268 of 4668 patients vs. 337 of 4672; hazard ratio, 0.78; 95% confidence interval [CI], 0.67 to 0.92; P=0.003). This result was driven primarily by the new onset of persistent macroalbuminuria, which occurred in fewer participants in the liraglutide group than in the placebo group (161 vs. 215 patients; hazard ratio, 0.74; 95% CI, 0.60 to 0.91; P=0.004). The rates of renal adverse events were similar in the liraglutide group and the placebo group (15.1 events and 16.5 events per 1000 patient-years), including the rate of acute kidney injury (7.1 and 6.2 events per 1000 patient-years, respectively). CONCLUSIONS: This prespecified secondary analysis shows that, when added to usual care, liraglutide resulted in lower rates of the development and progression of diabetic kidney disease than placebo. (Funded by Novo Nordisk and the National Institutes of Health; LEADER ClinicalTrials.gov number, NCT01179048 .).
2017
Liraglutide and Renal Outcomes in Type 2 Diabetes / Mann, Jfe; Ørsted, Dd; Brown-Frandsen, K; Marso, Sp; Poulter, Nr; Rasmussen, S; Tornøe, K; Zinman, B; Buse, Jb; Bergenstal R, LEADER Steering Committee and Investigators.; Daniels, G; Moses, Ac; Nauck, M; Nissen, S; Pocock, S; Steinberg, W; Stockner, M; Kristensen, P; Ravn, Ls; Zychma, M; Flyvbjerg, A; Ford, I; Kloos, Rt; Schactman, Mj; Sleight, P; Swedberg, K; Tenner, Sm; Akalın, S; Arechavaleta, R; Bain, S; Babkowski, Mc; Benroubi, M; Berard, L; Comlekci, A; Czupryniak, L; Eliasson, B; Eriksson, M; Fonseca, V; Franek, E; Gross, J; Hafidh, K; Haluzik, M; Hayes, F; Huang, Yy; Jacob, S; Kaddaha, G; Khalil, A; Kilhovd, B; Laakso, M; Leiter, L; Lalic, N; Ji, L; Luedemann, J; Mannucci, E; Marre, M; Masmiquel, L; Mota, M; Omar, M; O’Shea, D; Pan, C; Petrie, J; Pieber, T; Pratley, R; Raz, I; Rea, R; Rutten, G; Satman, I; Shestakova, M; Simpson, R; Smith, D; Tack, C; Tarnow, L; Thomas, N; Van Gaal, L; Travert, F; Vidal, J; Warren, M; Yoon, Kh; Tuttle, Rm; Sheerman, Si; Hegedüs, L; Baerwald, H; Bergenstal, M; Celik, S; Dias, C; Eder, M; Fitzgibbons, S; Irvhage, L; Kloluckova, J; Kriulianski, R; Mcduffie, R; Moen, S; Paster, A; Saalfeld, Rm; Sankar, K; Shehaj, E; Swierzewska, P; Tiktin, M; Tovey, S; Gibson, Cm; Chakrabarti, Ak; Dashe, Jf; Hinchey, J; Leary, Mc; Pride, Y; Wiviott, S; Allen, S; Mehr, Ap; Mutter, Wp; Parikh, S; Ray, S; Cheifetz, A; Leffler, D; Sheth, S; Alexander, E; Gaglia, Jl; Goessling, W; Mitzner, Ld; Rosenberg, C; Snow, Kj; Wagner, A; Piazza, G; Abell, S; Davis, T; D'Emden, M; Ding, Sa; Gilfillan, C; Greenaway, T; Gunawan, F; Ho, J; Jackson, R; Kalra, B; Lau, Sl; Lin, J; Macisaac, R; Makepeace, A; Malabu, U; Marjason, J; Mccallum, R; Mclean, M; Moin, N; Petersons, C; Price, S; Roberts, A; Roberts, D; Sangla, K; Stranks, S; Tan, Y; Thynne, T; Walters, J; Ward, G; Wen, W; Zhang, J; Brix, J; Feder, A; Höbaus, C; Höllerl, F; Höller, V; Kotter, T; Kratz, E; Krzizek, Ec; Leb-Stoeger, U; Mader, J; Mras, N; Novak, E; Obendorf, F; Peric, S; Pesau, G; Prager, R; Ribitsch, A; Schnack, C; Schernthaner, G; Schernthaner, G; Wascher, T; Batens, Ah; Benhalima, K; De Block, C; Ernest, P; Fouckova, A; Jandrain, B; Lapauw, B; Letiexhe, M; Mathieu, C; Neven, S; Peiffer, F; Ruige, J; Scheen, A; Taes, Y; Van Boxelaer, I; Vandistel, G; Van Durme, Y; Verhaegen, A; Alencar, E; Alencar, R; Almeida, Ac; B, Alves; Alves, E; Alves, G; Alves, J; Araujo, L; Arruda, V; Augusto, Ga; Baggentoss, R; Balestrassi, L; Barbosa, M; Barcelos, I; Belem, L; de Bem, A; Betti, Rt; Bona, R; Bosco, A; Branda, J; Bronstein, M; Bueno, T; Bulcão, T; Caiado, F; Camazzola, F; Cambréa, Mf; Campos, S; Campos, S; Canani, L; Carra, Mk; Caruso, S; Carvalho, N; Casillo, A; Castro, D; Cavalcanti, T; Cavichioli, V; Cercato, C; Chacra, A; Challela, W; Charchar, Hs; C, Chaves; Chrisman, C; Chrisman, C; Correia-Deur, J; da Costa, A Jr; Costa, M; Costi, B; Coutinho, P; Coutinho, W; Cunha, Mr; Daher, J Jr; Davini, E; Democh, D Jr; Eliaschewitz, F; Esmanhoto Facin, G; Farias, F; Felício, J; Fernandes, V; Filho, Cs; Filho, Ff; Filho, M; Fontan, D; Fontenele, Ap; Forti, A; Franco, D; Freire, K; Fusaro, A; Genestreti, P; Gerchman, F; Godi, A; Gomes, Kf; Gonçalves, P; R, Gonçalves; Griz, L; Grossman, M; Gurgel, Mh; Vasconcellos Haddad AW, ; Halpern, A; Hissa, M; Inuy, A; J, Jaime; Jonasson, T; Jorge, Jc; Malucelli, Fj; Kohara, S; Kramer, C; Lacerda, C; Ladeira, S; Lana, J; Lastebasse, F; Leitão, A; Leite, S; Lerário, Ac; Lima, D; Lima, M; Lippi, V; Lunardi, M; Machado, E; Maia, F; Maia, J; Maia, Kp; Mañas, N; Marchisotti, F; Marinho, C; C, Martins; Figueiredo de Medeiros, F; Melo, A; Melo, F; Mendonca, E; Mendonça, P; Filho, Rm; Miguel, M; Miléo, K; Miyahara, M; Montenegro, Ap; Moraes, A; Moreira, A; Ítalo Mota, J; Mothe, Fs; Murro, A; Nakatani, V; Napoli, Tf; Neto, Bg; Neto, Oq; Niclewicz, E; Ohe, Ln; Oliveira, F; Oliveira, M; Panarotto, D; Parente, E; Parolin, S; Pechmann, L; Costa da Penha, P; Perlamagna, L; Perotta, B; Pimentel, L; Pinto, M; Poço, C; Ponte, C; Prazeres, P; Quintao, E; Raduan, R; Rassi, Dt; Rassi, N; Reck, L; Montenegro, R Jr; Ribeiro, R; Rodovalho, S; Silveira Rodrigues, G; Rollin, G; Rossi, S; Sabino, C; Sales, Ap; Salles, J; Sampaio, Cr; Santana, L; Sato, V; da Silva Santos, M; Santos, Nl; Santos, R; Saraiva, J; Sartori, C; Sena, R; Sevilha, M; Sgarbi, J; Silva, D; Silva, D; D'albuquerque Silva, L; Silva, Me; Siqueira, K; Soares, S; Sobreira, W; Sousa, B; Souza, Ac; Souza, B; Tambascia, M; Tarantino, R; Tenor, F; Tomarchio, M; Triches, C; Tristão, Lj; Valenti, A; Vasques, E; Vencio, S; Vianna, A; Munhoz Vidotto, T; Vieira, S; Villar, H; Visconti, G; Volaco, A; Wajchenberg, B; Zanatta, L; Zimmerman, L; Abbott, Ec; Abu-Bakare, A; Advani, A; Allison, R; Bishara, P; Bowering, Ck; Cheng, A; Chouinard, S; Clayton, D; Conway, J; D'Amours, M; de Tugwell, B; Deyoung, P; D'Ignazio, G; Dube, F; Ekoe, Jm; Fagan, S; Garceau, C; Gottesman, I; Hanna, A; Harris, S; Hramiak, Im; Hurd, C; Imran, S; Josse, R; Joyce, C; Kaiser, S; Khan, F; I, Kirouac; Kovacs, C; Labonte, I; Langlois, Wj; Levac, Mf; Liutkus, J; Mcdonald, C; Milosevic, V; Nyomba, Bl; Paul, T; Raby, K; Ransom, T; Reichert, Sm; Retnakaran, R; Rabasa-Lhoret, R; Raff, E; Shaikholeslami, R; Sigalas, J; Yip, Ce; Weisnagel, Sj; Woo, V; Bao, Y; Cai, X; Chen, J; Chen, K; Chen, M; Chen, X; Chen, Y; Ji, Y; Lei, J; Li, H; Liu, P; Mu, Y; Ren, M; Ren, Y; Shi, Y; Wang, D; Wang, F; Wang, J; Wang, Y; Yan, L; Yang, G; Yang, J; Yu, X; Yuan, G; Xu, M; Zhao, X; Zheng, J; Zhou, L; Anderlová, K; Brožová, J; Haluzík, M; Hanušová, V; Kosák, M; Křížová, J; Mráz, M; Owen, K; Rušavý, Z; Tomešová, J; Trachta, P; Žourek, M; Andersen, Ph; Boesgaard, T; Christensen, S; Gram, J; Gregersen, S; Henriksen, Je; Hermansen, K; Jakobsen, Pe; Jensen, J; Krogsaa, A; Larsen, M; Lervang, Hh; Madsbad, S; Mortensen, L; Olesen, T; Pietraszek, A; Ridderstråle, M; Safai, N; Schioldan, Ag; Schmidt, C; Snorgaard, O; Stidsen, J; Cederberg, H; Haapamäki, H; Hukkanen, J; Jauhiainen, R; Kujari, Ml; Lahtela, J; Laine, M; Mäkelä, J; Miilunpohja, M; Savolainen, M; Taurio, J; Vänttinen, M; Creton, C; Cosma, Nv; Dillinger, J; Jacques, Jl; Guedj, Am; Moulla, M; Petit, C; Ratsianoharana, V; Richter, D; Rodier, M; Roussel, R; Hinz, A; Politz, E; Esser, M; Deuse, U; Mittag, D; Hagenow, A; Jacob, F; Jordan, R; Gantke, D; Venschott-Jordan, U; Löhr, C; Klausmann, G; Eschenbrücher, K; Karakas, M; Jahrsdörfer, B; Kunze, Mr; Wöhrle, J; König, W; Spielhagen, H; Kilimnik, A; Lüdemann, Hp; Lüdemann, J; Mölle, A; Mölle, M; Müller, J; Appelt, S; Sauter, A; Sauter, J; Hartmann, U; Löw, A; Krötz, F; Sohn, Hy; von Schacky, C; Klauss, V; Braun, D; Segner, A; Degtyareva, E; Kreutzmann, K; Paschmionka, R; Hauck, N; Sihal, O; Busch, Ak; Maus, O; Stübler, P; Füllgraf-Horst, S; Vietzke, A; Müller, C; Tosch-Sisting, R; Lengsfeld, B; Thaler, J; Schaum, T; Steindorf, J; Steindorf, S; König, A; Reitschuster, S; Schlott, D; Clever, Hu; Witzel, P; Kempe, Hp; Stemler, L; Benis, A; Diakoumopoulou, E; Kazakos, K; Kypraios, N; Liatis, S; 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