(B49) Comparative cardiovascular effectiveness of liraglutide 3 mg

Publication Number: 659

Background: Liraglutide 3 mg is a glucagon-like peptide-1 receptor agonist currently approved for weight loss. The LEADER trial found lower cardiovascular (CV) risk vs placebo for up to 1.8 mg/d of liraglutide in patients with diabetes.

Objectives: We aimed to assess the comparative CV effectiveness of liraglutide 3 mg vs. an alternative treatment for weight loss.

Methods: Using two commercial claims databases, we conducted a new-user, active-comparator cohort study comparing adults initiating liraglutide 3 mg to 1:1 propensity score matched patients initiating naltrexone-bupropion on 70 potential confounders (e.g. obesity related comorbidities) between 05-15 to 12-21/03-22. Pooled hazard ratios (HR) and 95% confidence intervals (CI) were computed to assess the risk of a primary composite CV outcome, comprising four atherosclerotic CV events (myocardial infarction, stroke, coronary procedure, and unstable angina) and hospitalization for heart failure (HHF). Secondary outcomes were the individual components of the primary CV outcome. We used an intention to treat (ITT) exposure definition censoring after 12 months of follow-up. Patients were followed from cohort entry until the occurrence of an outcome, death, end of insurance coverage, or end of the study period. In sensitivity analyses, we used an as treated approach, censoring at treatment discontinuation.

Results: Among 36,902 propensity score-matched pairs (mean age, 45.8 years; 82.2% female), there were 137 composite CV events (incidence rate [IR]: 4.4 per 1000 person-years) among liraglutide 3 mg initiators compared with 145 events (IR: 4.7) among naltrexone-bupropion initiators (pooled adjusted HR: 0.95; 95%CI: 0.75-1.19). For the outcome of atherosclerotic event, the pooled HR was 1.04 (0.76-1.42), and for HHF, the pooled adjusted HR was 0.84 (0.61-1.15). Results from the as treated analyses were consistent.

Conclusions: Compared to naltrexone-bupropion, liraglutide 3 mg was associated with a similar risk of a composite CV outcome and with a trend towards a slightly lower risk of HHF, though confidence intervals were wide. Planned future analyses, including an increasing number of exposed patients as they become available over time, will provide more precise associations.