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• W2964603908 abstract "ELIXA was the only GLP-1RA CVOT that failed to show any CV benefit over usual care. In LEADER, SUSTAIN-6, HARMONY Outcomes, and REWIND, GLP-1RA showed statistical superiority on MACEs compared to usual care, while EXSCEL (P=0.06) just grazed it and PIONEER 6 showed a nonsignificant 21% reduction (P=0.17). However, SUSTAIN-6 lacked a prespecified analysis for superiority. Dulaglutide significantly decreased the incidence of MACEs by 12% in a population at a lower CV risk compared to previous CVOT. Although GLP-1RA CVOT were not powered to detect such differences, GLP-1RA seemed to affect the individual MACE components according to specific patterns: liraglutide and oral semaglutide produced significant reductions of CV death; subcutaneous semaglutide and dulaglutide promoted a significant decrease in non-fatal stroke; albiglutide largely reduced non-fatal MI; and exenatide LAR did not show a significant effect in any component. The latest recommendations from the American Diabetes Association and the European Association for the Study of Diabetes prioritize the use of drugs with proven cardiovascular (CV) benefit in patients with established CV disease. Especially among the glucagon-like peptide (GLP)-1 receptor agonists (GLP-1RA) class, results of cardiovascular outcomes trials (CVOT) have been heterogeneous. Baseline characteristics of the population, study design, drugs in the control arm, modifications of CV risk factors, including glycemic control, reduction of hypoglycemia, and the GLP-1RA direct effects on CV cells and tissues, were considered. Ultimately, the time of exposure to the GLP-1RA appears to be the factor most prominently explaining trial heterogeneity. Thus, the CV benefit should be regarded as a class effect of GLP-1RA, as largely similar results are seen for drugs sharing a common mechanism of action. The latest recommendations from the American Diabetes Association and the European Association for the Study of Diabetes prioritize the use of drugs with proven cardiovascular (CV) benefit in patients with established CV disease. Especially among the glucagon-like peptide (GLP)-1 receptor agonists (GLP-1RA) class, results of cardiovascular outcomes trials (CVOT) have been heterogeneous. Baseline characteristics of the population, study design, drugs in the control arm, modifications of CV risk factors, including glycemic control, reduction of hypoglycemia, and the GLP-1RA direct effects on CV cells and tissues, were considered. Ultimately, the time of exposure to the GLP-1RA appears to be the factor most prominently explaining trial heterogeneity. Thus, the CV benefit should be regarded as a class effect of GLP-1RA, as largely similar results are seen for drugs sharing a common mechanism of action. arithmetic difference between the event rate in the control and experimental groups, respectively. a highly regulated programmed cell death; both defective and excessive apoptosis are linked to a wide variety of diseases. abbreviation for cyclic adenosine monophosphate; it is a second messenger involved in many relevant biological processes. trials designed to ensure that each new antihyperglycemic therapy did not induce an unacceptable increase in cardiovascular risk, mandatory after the FDA guidance issued in 2008. pharmacokinetic parameter that indicates the time it takes for the total amount of a drug in the body to be reduced by 50%. comparison between the probability of an event to happen in the experimental and control groups, respectively. it constitutes the primary outcome of all GLP-1RA CVOT and comprises cardiovascular death, non-fatal stroke, and non-fatal myocardial infarction. ELIXA is the only GLP-1RA CVOT addressing a 4-point MACE, including hospitalization for unstable angina. abbreviation for cAMP responding element–binding protein; it is a transcription factor that binds to certain DNA sequences to increase or decrease gene transcription. It has pleiotropic actions. abbreviation for extracellular signal-regulated protein kinases 1 and 2; they mediate cell proliferation and survival phosphorylating, thus activating multiple transcription factors. abbreviation for c–Jun N–terminal kinases; they respond to stress stimuli (i.e., cytokines, UV shock) modifying by phosphorylation the activity of numerous proteins of the mitochondria or the nucleus. They are involved in apoptosis, inflammation, cell differentiation, and proliferation. difference between the event rate in the control and experimental groups, respectively, expressed as a proportion of the event rate in the control group. precedes the actual beginning of a clinical trial and can be passive (patients receive no treatment or placebo) or active (patients receive treatment). It is useful to assess patient compliance, washout previous medications, and standardize background therapy." @default.
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• W2964603908 date "2019-09-01" @default.
• W2964603908 modified "2023-09-26" @default.
• W2964603908 title "Heterogeneity and Similarities in GLP-1 Receptor Agonist Cardiovascular Outcomes Trials" @default.
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• W2964603908 doi "https://doi.org/10.1016/j.tem.2019.07.004" @default.
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