Comparison of Two Glucagon-Like-Peptide-1 Analogs (GLP -1) Dulaglutide vs Liraglutide for the Management of Diabetes in Solid Organ Transplant (SOT)

P. Singh, M. Taufeeq, T. E. Pesavento, K. Washburn, D. Walsh, S. Meng

Ohio State University, Columbus, OH

Meeting: 2019 American Transplant Congress

Abstract number: 123

Keywords: Graft survival, Metabolic complications, Metabolic disease, Post-transplant diabetes

Session Information

Session Name: Concurrent Session: Kidney: Cardiovascular and Metabolic I

Session Type: Concurrent Session

Date: Sunday, June 2, 2019

Session Time: 4:30pm-6:00pm

Presentation Time: 5:42pm-5:54pm

Location: Ballroom C

*Purpose: Poorly controlled Type-2 diabetes is an important contributor to graft dysfunction, and cardiovascular morbidity in the SOT. GLP-1-analog has been widely used in the general Diabetic patients, but studies are meager in SOT. In our retrospective study, we compared the GLP-1 analogs, dulaglutide with liraglutide for efficacy and safety in SOT.

*Methods: We performed a retrospective, chart review of SOT recipients (more than 18 years) with diabetes. We identified 63 and 25 recipients on dulaglutide and liraglutide respectively and collected data at 6, 12 and 24 months. The primary endpoint was: reduction in weight, BMI, and insulin requirement. Safety endpoint included hypoglycemia, GI side-effects, and cancers. Secondary endpoints were: HbA1c, renal and liver function.

*Results: Percentage decrease in weight was 2, 4% and 5.2% with dulaglutide (baseline mean-weight 98.7 kgs) and 0.09%, 0.87% and 0.89% with liraglutide (baseline mean-weight 112.6 kg) at 6, 12 and 24 months respectively. BMI followed a similar trend with percentage reduction of 2.4, 6, and 8% with dulaglutide (baseline mean-BMI 32.8kg/m2) and minimal decreases of 0.24, 1.4, and 0.54% with liraglutide (baseline mean-36.8 Kg/m2) at 6, 12 and 24 months respectively. The percentage reduction for insulin requirement was 26% with dulaglutide when compared to 3.6% with liraglutide at the end of follow-up. The baseline insulin requirement in dulaglutide was 23 units when compared to 50 units with liraglutide. Mean baseline A1c was 7.5 with both the GLP-1-analogs. There was a trend of decrease of HbA1c throughout the follow-up for dulaglutide with a percentage decrease of A1c being 10%, 5.3% and 8.4% at 6, 12, and 24 months respectively. Whereas, in liraglutide group, there was an initial decrease followed by an increase in A1c (percentage decrease of 5.3%, 3% at 6, and 12 months followed by an increase of 2% in A1c at 24 months). There was a 10% reduction in creatinine and a 15% increase in egfr at the end of 24 months with dulaglutide (baseline creatinine 1.73 and egfr 47). Whereas there was an increase in creatinine by 7% at the end of 24 months with liraglutide. The trend reflected in a decrease in egfr of 8% with liraglutide at the end of the study period (baseline creatinine 1.85 and egfr 42.48). There was no increased incidence of pancreatitis, transaminitis or cancer. Immunosuppressive agents remained unchanged with both the GLP-1-analogue. Hypoglycemia or other GI manifestations was lower in both the groups, none requiring discontinuation of medications. There was one graft failure, anginal episode, and two mortality each in dulaglutide, and liraglutide group throughout the follow-up.

*Conclusions: Both agents exhibited a favorable side-effect profile without any interference with immunosuppressant. There was a sustained reduction in weight, BMI, insulin requirement and HbA1c with Dulaglutide when compared to liraglutide. Future prospective randomized trials are warranted.

Baseline characteristics of the study population for dulaglutide, and liraglutide
Characteristics	Dulaglutide	Liraglutide	Units
Age, median (range)	58 (30, 74)	57 (35, 76)	years
Percentage of patients per race/ethnicity	White -71 Black – 23 Hispanic – 5 Other -1	White – 68 Black – 28 Hispanic – 4	%
Percentage type of organ transplant	Kidney – 81 Liver – 16 Liver-Kidney – 1.5 Heart – 1.5	Kidney – 84 Liver – 4 Kidney-Pancreas – 8 Heart – 4	%
Percentage Immunosuppression based on drug class	Calcineurin inhibitors (CNI) – 81% Cell cycle inhibitors (CCI) – 57% mTOR inhibitors – 54% Maintenance steroid – 21% Belatacept – 3% Steroid used for rejection – 22%	Calcineurin inhibitors (CNI) – 64% Cell cycle inhibitors (CCI) – 60% mTOR inhibitors – 64% Maintenance steroid – 8% Belatacept – 8% Steroid used for rejection – 4%	%
Percentage of patients based on CKD stages	CKD 1 – 1.5% CKD 2 – 25.6% CKD 3a – 22.2% CKD 3b – 30.15% CKD 4 – 20.6% CKD 5, and ESRD – 0	CKD 1 – 0% CKD 2 – 24% CKD 3a – 16% CKD 3b – 44% CKD 4 – 16% CKD 5, and ESRD – 0	%
History of Cardiovascular disease before GLP1 (Angina, non-fatal MI, stroke, CHF)	33	40	%
Percentage Male	68	72	%

To cite this abstract in AMA style:

Singh P, Taufeeq M, Pesavento TE, Washburn K, Walsh D, Meng S. Comparison of Two Glucagon-Like-Peptide-1 Analogs (GLP -1) Dulaglutide vs Liraglutide for the Management of Diabetes in Solid Organ Transplant (SOT) [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/comparison-of-two-glucagon-like-peptide-1-analogs-glp-1-dulaglutide-vs-liraglutide-for-the-management-of-diabetes-in-solid-organ-transplant-sot/. Accessed November 22, 2024.

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