These data from real-world observations demonstrate a higher risk for cardiovascular events in patients with a CYP2C19 loss-of-function allele if clopidogrel versus alternative therapy is prescribed. A future randomized study of genotype-guided antiplatelet therapy may be of value.

Background: Prior data evaluating risk of severe UTI infections with Sodium-Glucose Co-Transporter 2 inhibitors (SGLT2i) have reported conflicting findings.Objective: To assess whether patients initiating SGLT2i were at an increased risk of developing severe UTI events compared to those initiating Dipeptidyl peptidase-4 inhibitors (DPP-4i) and Glucagon-like Peptide 1 receptor agonists (GLP1a). Design-Population-based cohort study Setting-Two large US-based commercial claims databases (March 2013 -September 2015)Participants-Within each database, two cohorts of 1:1 propensity score-matched patients 18 years and older with type 2 diabetes mellitus, initiating SGLT2 inhibitors vs DPP-4 inhibitors (cohort 1) or GLP1 agonists (cohort 2) Measurements: The primary outcome was a severe UTI event, defined as a hospitalization for either primary UTI, sepsis with UTI or pyelonephritis; secondary outcome was outpatient UTI treated with antibiotics. Hazard ratios [HRs] were estimated in each propensity-score matched cohort adjusting for more than 90 baseline characteristics.Results-After 1:1 PS matching, we identified 123,752 patients in cohort 1 and 111,978 patients in cohort 2 in the two databases. In cohort 1, there were 61 severe UTI events among initiators of SGLT2 inhibitors (incidence rate [IR] per 1,000 person-years=1.76) v 57 in the DPP-4 inhibitor group (IR =1.77), corresponding to a HR of 0.98 (95% CI, 0.68, 1.41). In cohort 2, there were 73 events in the SGLT2 inhibitor group (IR=2.15) vs 87 in the GLP1 agonist group (IR=2.

There is a paucity of data evaluating recent changes in clinical and prescriber characteristics of patients initiating sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA). RESEARCH DESIGN AND METHODS U.S.-based administrative claims data (July 2013 to June 2018) were used to identify initiators of SGLT2i and GLP-1RA. RESULTSOver 5 years, empagliflozin initiation (as a proportion of SGLT2i) increased by 57.1% (P < 0.001 for trend), while canagliflozin initiation declined by 75.1% (P < 0.001). Empagliflozin was the only agent within SGLT2i with an increase in the proportion of patients with myocardial infarction, stroke, or heart failure (collectively called CVD-HF) (P < 0.001). Liraglutide initiation (as a proportion of total GLP-1RA) declined by 32.1% (P < 0.001), and dulaglutide initiation increased by 34.1% (P < 0.001); the proportion of patients with CVD-HF increased the most in liraglutide initiators (5.1% increase; P < 0.001). Most prescribers were internists or endocrinologists; cardiologist prescribing remained low (<1%). CONCLUSIONSFor SGLT2i, shifts in preference for empagliflozin followed changes in drug labels and guidelines, while for GLP-1RA, other factors such as price or ease of administration may have led to a preference for dulaglutide over liraglutide.

No abstract