Effectiveness and safety of glucagon‐like peptide‐1 receptor agonist in a cohort of kidney transplant recipients

Vigara, Luis Alberto; Villanego, Florentino; Orellana, Cristhian; Naranjo, Javier; Torrado, Julia; García, Teresa Martín; Mazuecos, Auxiliadora

doi:10.1111/ctr.14633

Cited by 13 publications

(23 citation statements)

References 7 publications

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“…There has been some concern that GLP1RA‐induced gastric emptying delay may affect tacrolimus exposure 59 . While tacrolimus or CNI doses were lowered to maintain levels in two studies, four studies observed no significant effects on tacrolimus levels with GLP1RA therapy 53–58 . Putting these together, the impact of GLP1RA on tacrolimus levels seems minimal and manageable by therapeutic drug monitoring.…”

Section: Resultsmentioning

confidence: 99%

“…whose study cohort had poorly controlled T2DM at baseline 57 . Variable weight loss of .2–9.9 kg was observed in seven studies with no significant changes in the remaining two studies 50–53,55–58 . Since diabetic nephropathy is a progressive disease, it was not possible to assess renoprotective effects of GLP1RA without adequate control arms.…”

Section: Resultsmentioning

confidence: 99%

“…Since diabetic nephropathy is a progressive disease, it was not possible to assess renoprotective effects of GLP1RA without adequate control arms. In eight studies that included eGFR, either no significant changes or slight improvements from baseline were reported 50–53,55–58 . Of note, no study reported worsening eGFR on GLP1RA therapy.…”

Section: Resultsmentioning

confidence: 99%

“…Of note, no study reported worsening eGFR on GLP1RA therapy. Three studies included data on proteinuria, with no change in two studies and a decrease in one study 53,55,58 …”

Section: Resultsmentioning

confidence: 99%

“…Seven studies reported the need to reduce concomitant insulin dose and/or oral antidiabetic agents after GLP1RA initiation 50,51,53,56,58 . The mean reduction in insulin dose ranged from 4 unit/day up to 30 unit/day across the studies.…”

Section: Resultsmentioning

confidence: 99%

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Sweet and simple as syrup: A review and guidance for use of novel antihyperglycemic agents for post‐transplant diabetes mellitus and type 2 diabetes mellitus after kidney transplantation

Lawrence

Chandran

Park

et al. 2023

Clinical Transplantation

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Uncontrolled type 2 diabetes mellitus (T2DM) and post-transplant diabetes mellitus (PTDM) increase morbidity and mortality after kidney transplantation. Conventional strategies for diabetes management in this population include metformin, sulfonylureas, meglitinides and insulin. Limitations with these agents, as well as promising new antihyperglycemic agents, create a need and opportunity to explore additional options for transplant diabetes pharmacotherapy. Novel agents including sodium glucose co-transporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP1RA), and dipeptidyl peptidase IV inhibitors (DPP4i) demonstrate great promise for T2DM management in the non-transplant population. Moreover, many of these agents possess renoprotective, cardiovascular, and/or weight loss benefits in addition to improved glucose control while having reduced risk of hypoglycemia compared with certain other conventional agents. This comprehensive review examines available literature evaluating the use of novel antihyperglycemic agents in kidney transplant recipients (KTR) with T2DM or PTDM. Formal grading of recommendations assessment, development, and evaluation (GRADE) system recommendations are provided to guide incorporation of these agents into post-transplant care. Available literature was evaluated to address the clinical questions of which agents provide greatest shortand long-term benefits, timing of novel antihyperglycemic therapy initiation after transplant, monitoring parameters for these antihyperglycemic agents, and concomitant antihyperglycemic agent and immunosuppression regimen management. Current experience with novel antihyperglycemic agents is primarily limited to single-center retrospective studies and case series. With ongoing use and increasing comfort, further and more robust research promises greater understanding of the role of these agents and place in therapy for kidney transplant recipients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Of note, no study reported worsening eGFR on GLP1RA therapy. Three studies included data on proteinuria, with no change in two studies and a decrease in one study 53,55,58 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Sweet and simple as syrup: A review and guidance for use of novel antihyperglycemic agents for post‐transplant diabetes mellitus and type 2 diabetes mellitus after kidney transplantation

Lawrence

Chandran

Park

et al. 2023

Clinical Transplantation

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Prescribing practices and barriers to use of sodium‐glucose cotransporter 2 inhibitors and glucagon‐like Peptide‐1 receptor agonists in adult kidney transplant recipients: A survey of endocrinology and nephrology prescribers

Walter,

Choksi,

Papaleontiou

et al. 2024

J Am Coll Clin Pharm

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Clinical practice variability exists regarding the use of sodium‐glucose cotransporter 2 inhibitors (SGLT2i) and glucagon‐like peptide‐1 receptor agonists (GLP‐1RA) in kidney transplant recipients (KTRs). The objective of this study was to understand prescribing practices and barriers for the use of SGLT2i and GLP‐1RA among endocrinology and nephrology prescribers caring for KTRs. A 19‐item electronic survey assessing prescribing practices and barriers for the use of SGLT2i and GLP‐1RA in adult KTRs was distributed to all members of the Planning Research in Inpatient Diabetes/Planning Research in Outpatient Diabetes (PRIDE/PROUD) group and the American Society of Transplantation Kidney Pancreas Community of Practice via email listservs between July and November 2023. Endocrinology and nephrology prescribers caring for adult KTRs with type 2 diabetes mellitus (T2DM) or post‐transplant diabetes mellitus (PTDM) were eligible. A total of 50 responses were included for analysis (n = 25 endocrinology, n = 25 nephrology). Respondents prescribed SGLT2i and GLP‐1RA to adult KTRs with T2DM/PTDM with the following frequency: always (4% SGLT2i, 6% GLP‐1RA), often (34% SGLT2i, 30% GLP‐1RA), sometimes (34% SGLT2i, 36% GLP‐1RA), rarely (22% SGLT2i, 20% GLP‐1RA), or never (6% SGLT2i, 8% GLP‐1RA). The most common indication for both drug classes was diabetes mellitus (DM)/hyperglycemia (84% SGLT2i, 90% GLP‐1RA). Most prescribers felt comfortable initiating a SGLT2i (58%) or GLP‐1RA (62%) between 1 and 6 months post‐transplant. Prescribers were always or often concerned about infection (67%) with the use of SGLT2i and gastrointestinal intolerance (66%) with GLP‐1RA. Cost of treatment/insurance coverage/need for prior authorization and patient concern for drug cost was identified as being very likely or likely barriers for prescribing these drug classes post‐transplant (54% SGLT2i, 62% GLP‐1RA). SGLT2i and GLP‐1RA are prescribed mainly for DM/hyperglycemia by endocrinology and nephrology prescribers between 1 and 6 months postkidney transplant. Concerns surrounding medication access and cost were the most frequently reported barriers to use.

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Evaluating the use of glucagon‐like peptide‐1 receptor agonists in a matched cohort of kidney and liver transplant recipients

Baik,

Jantz,

Poparad‐Stezar

et al. 2024

Pharmacy Practice and Res

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BackgroundDiabetes mellitus (DM) and obesity are common among solid organ transplant recipients, but are associated with an increased risk of graft failure.AimAlthough glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) are effective for managing both conditions in the general population, there is limited evidence regarding their use among transplant recipients.MethodThe effect of GLP‐1 RAs on post‐transplant glucose control (defined as haemoglobin A1c [HbA1c]) among 37 liver and kidney transplant patients was compared to a control cohort. Secondary outcomes included change in total daily insulin requirements and oral DM agents, estimated glomerular filtration rate (eGFR), weight, and body mass index (BMI). Adverse events attributed to GLP‐1 RAs, hypoglycaemia, incidence of pancreatitis, biopsy‐proven acute rejection, graft loss, and death were assessed. Ethical approval was granted by the Henry Ford Health Institutional Review Board (Reference no: 15959) and the study conforms with the US Federal Policy for the Protection of Human Subjects.ResultsWe observed that patients receiving GLP‐1 RAs had a median reduction in HbA1c of 0.5% and reduction in insulin and oral anti‐DM agents compared to the control group without GLP‐1 RAs. There were statistically significant reductions in both weight and BMI in the GLP‐1 RA group. Our observed incidence of adverse events was similar to previous literature. Unlike other smaller studies, a decline in eGFR was observed in the GLP‐1 RA group. There were no differences in incidence of biopsy‐proven acute rejection, graft loss, or death.ConclusionWhen compared to patients without GLP‐1 RA therapy, GLP‐1 RAs modestly reduced HbA1c and insulin requirements and statistically reduced weight/BMI review at 6 months. GLP‐1 RAs, even if initiated early post‐transplant, were seemingly safe and effective. Larger, prospective studies are warranted to evaluate the safety and efficacy of GLP‐1 RAs in this population.

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Effectiveness and safety of glucagon‐like peptide‐1 receptor agonist in a cohort of kidney transplant recipients

Cited by 13 publications

References 7 publications

Sweet and simple as syrup: A review and guidance for use of novel antihyperglycemic agents for post‐transplant diabetes mellitus and type 2 diabetes mellitus after kidney transplantation

Sweet and simple as syrup: A review and guidance for use of novel antihyperglycemic agents for post‐transplant diabetes mellitus and type 2 diabetes mellitus after kidney transplantation

Prescribing practices and barriers to use of sodium‐glucose cotransporter 2 inhibitors and glucagon‐like Peptide‐1 receptor agonists in adult kidney transplant recipients: A survey of endocrinology and nephrology prescribers

Evaluating the use of glucagon‐like peptide‐1 receptor agonists in a matched cohort of kidney and liver transplant recipients

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