1142-P: Comparison of Hospitalization for Heart Failure (HHF) among Patients with Type 2 Diabetes Mellitus (T2DM) and Macroalbuminuria Initiated on Canagliflozin (CANA) or a DPP-4

Abstract

This study compared the risk of HHF in T2DM patients with macroalbuminuria initiated on CANA or DPP-4 using real-world insurance claims data.

Adults with a T2DM diagnosis and a urine albumin-to-creatinine ratio >300 mg/g or albumin excretion rate >300 mg/day, initiated on CANA or DPP-4 after 03/29/2013, with at least 6 months of pre-initiation insurance eligibility were selected from Optum’s Clinformatics^TM Data Mart database (03/2012-03/2019). Patients were excluded if they notably had a diagnosis for T1DM, acute kidney injury, or stage 5 chronic kidney disease at baseline. The observation period was censored at the earliest of the index drug discontinuation, a claim for a drug from the alternate index cohort (DPP-4 or CANA), or the end of eligibility or data. Inverse probability of treatment weighting (IPTW) accounted for differences in baseline demographics, clinical characteristics, and healthcare costs. HHF events were defined as inpatient stays with a diagnosis of heart failure (ICD-9: 428.x; ICD-10: I50.x). Rates of HHF events per 100 patient-years (PY) were calculated and weighted Cox proportional hazards model accounting for repeated measurement was used to estimate the hazard ratio (HR), 95% confidence interval (CI), and p-value.

A total of 759 patients were initiated on CANA and 1,892 on a DPP-4. After IPTW balanced baseline characteristics, mean age was ∼64 years old, ∼40% were female, and mean HbA1c was ∼9.0%. Among CANA and DPP-4 patients, respectively, the mean observation period was 5.4 and 6.6 months and the rate of HHF events per 100 PY was 0.57 and 3.73. At 12 months, the hazard for HHF was 74% lower among patients initiated on CANA relative to patients initiated on DPP-4 (HR [95%CI]: 0.26 [0.07-0.91]; p=0.0343).

In this real-world analysis of patients with T2DM and macroalbuminuria during the initial months on therapy, patients on CANA had a significantly lower risk of HHF events compared to patients on DPP-4.