Certain glucose-lowering meds associated with lower risk for COPD exacerbations

For patients with type 2 diabetes (T2D) and chronic obstructive pulmonary disorder (COPD), sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are associated with a reduced risk for moderate or severe COPD exacerbations compared with dipeptidyl peptidase 4 inhibitors (DPP-4is), according to a study published online Feb. 10 in JAMA Internal Medicine.

Avik Ray, M.D., from Brigham and Women’s Hospital and Harvard Medical School in Boston, and colleagues conducted a comparative effectiveness study to assess the risk for moderate or severe COPD exacerbations among patients aged 40 years or older with T2D and active COPD who initiated treatment with SGLT-2is versus DPP-4is; GLP-1 RAs versus DPP-4is; and SGLT-2is versus GLP-1 RAs (27,991; 32,107; and 36,218 pairs, respectively).

The researchers found that the risk for moderate or severe COPD exacerbation was lower among those treated with SGLT-2is versus DPP-4is and among those treated with GLP-1 RAs versus DPP-4is (9.26 versus 11.4 per 100 person-years [hazard ratio, 0.81] and 9.89 versus 11.49 per 100 person-years [hazard ratio, 0.86], respectively), with minimal differences observed among those treated with SGLT-2is versus GLP-1 RAs. Across sensitivity and subgroup analyses, the results were consistent.

“These findings suggest that SGLT-2is and GLP-1 RAs may be preferable to DPP4is when deciding among glucose-lowering medications for patients with T2D and active COPD,” the authors write. “However, given the observational nature of the study, there is potential for residual or unmeasured confounding, and findings from similar clinical studies and clinical trials will help corroborate these results.”

Several authors disclosed ties to the pharmaceutical industry; one author disclosed being an expert witness in litigation against inhaler manufacturers.

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