Lixisenatide in Patients with Type 2 Diabetes and Acute Coronary Syndrome

被引:1789
作者
Pfeffer, Marc A. [1 ,2 ]
Claggett, Brian [1 ,2 ]
Diaz, Rafael [3 ]
Dickstein, Kenneth [4 ]
Gerstein, Hertzel C. [5 ]
Kober, Lars V. [6 ]
Lawson, Francesca C. [7 ]
Ping, Lin [7 ]
Wei, Xiaodan [7 ]
Lewis, Eldrin F. [1 ,2 ]
Maggioni, Aldo P. [8 ]
McMurray, John J. V. [9 ]
Probstfield, Jeffrey L. [10 ]
Riddle, Matthew C. [11 ]
Solomon, Scott D. [1 ,2 ]
Tardif, Jean-Claude [12 ]
机构
[1] Brigham & Womens Hosp, Div Cardiovasc, Boston, MA 02115 USA
[2] Harvard Univ, Sch Med, Boston, MA USA
[3] Estudios Clin Latinoamer, Rosario, Argentina
[4] Univ Bergen, Stavanger Univ Hosp, Stavanger, Norway
[5] McMaster Univ, Hamilton, ON, Canada
[6] Univ Copenhagen Hosp, Rigshosp, DK-2100 Copenhagen, Denmark
[7] Sanofi US, Bridgewater, NJ USA
[8] Italian Assoc Hosp Cardiologists, Res Ctr, Florence, Italy
[9] Univ Glasgow, British Heart Fdn Cardiovasc Res Ctr, Glasgow, Lanark, Scotland
[10] Univ Washington, Med Ctr, Seattle, WA 98195 USA
[11] Oregon Hlth & Sci Univ, Portland, OR 97201 USA
[12] Univ Montreal, Montreal Heart Inst, Montreal, PQ, Canada
关键词
GLUCAGON-LIKE PEPTIDE-1; CONGESTIVE-HEART-FAILURE; CARDIOVASCULAR OUTCOMES; MYOCARDIAL-INFARCTION; RECEPTOR AGONISTS; GLYCEMIC CONTROL; DOUBLE-BLIND; FOLLOW-UP; MELLITUS; GLUCOSE;
D O I
10.1056/NEJMoa1509225
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Cardiovascular morbidity and mortality are higher among patients with type 2 diabetes, particularly those with concomitant cardiovascular diseases, than in most other populations. We assessed the effects of lixisenatide, a glucagon-like peptide 1-receptor agonist, on cardiovascular outcomes in patients with type 2 diabetes who had had a recent acute coronary event. METHODS We randomly assigned patients with type 2 diabetes who had had a myocardial infarction or who had been hospitalized for unstable angina within the previous 180 days to receive lixisenatide or placebo in addition to locally determined standards of care. The trial was designed with adequate statistical power to assess whether lixisenatide was noninferior as well as superior to placebo, as defined by an upper boundary of the 95% confidence interval for the hazard ratio of less than 1.3 and 1.0, respectively, for the primary composite end point of cardiovascular death, myocardial infarction, stroke, or hospitalization for unstable angina. RESULTS The 6068 patients who underwent randomization were followed for a median of 25 months. A primary end-point event occurred in 406 patients (13.4%) in the lixisenatide group and in 399 (13.2%) in the placebo group (hazard ratio, 1.02; 95% confidence interval [CI], 0.89 to 1.17), which showed the noninferiority of lixisenatide to placebo (P < 0.001) but did not show superiority (P = 0.81). There were no significant between-group differences in the rate of hospitalization for heart failure (hazard ratio in the lixisenatide group, 0.96; 95% CI, 0.75 to 1.23) or the rate of death (hazard ratio, 0.94; 95% CI, 0.78 to 1.13). Lixisenatide was not associated with a higher rate of serious adverse events or severe hypoglycemia, pancreatitis, pancreatic neoplasms, or allergic reactions than was placebo. CONCLUSIONS In patients with type 2 diabetes and a recent acute coronary syndrome, the addition of lixisenatide to usual care did not significantly alter the rate of major cardiovascular events or other serious adverse events. (Funded by Sanofi; ELIXA ClinicalTrials.gov number, NCT01147250.)
引用
收藏
页码:2247 / 2257
页数:11
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