Abstract Details

Title Efficacy and Safety of Novel Diabetes Drugs for Stroke Prevention: Systematic Review, Meta-analysis, and Meta-regression

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 5-017

Objective Investigate efficacy and safety of sodium–glucose cotransporter 2 inhibitors (SGLT2i) as well as glucagon-like peptide 1 receptor (GLP-1RA) and peroxisome proliferator-activated receptor-γ agonists (PPAR-γ) on stroke prevention.

Background Data from randomized clinical trials (RCT) show that novel diabetic drugs (NDD) reduce the risk of major cardiovascular events. Clinical equipoise remains on their effect on stroke risk.

Design/Methods We performed a systematic database search from inception to September 30, 2023, to identify RCTs that investigated the efficacy of NDD on stroke outcomes. The primary outcome was total stroke rate, and the safety outcome was overall mortality rate, as defined in each trial. Effect size was represented by risk ratio (RR), and analyses were done using random-effects models. Heterogeneity was assessed by I² statistics. In meta-regression analysis, we investigated the association of glycated hemoglobin levels (HbA1c) with stroke risk.

Results

We analyzed 27 RCTs (9 studies- GLP-1RA, 6 studies- PPAR- γ and 12 studies- SGLT2i), comprising 166,991 patients. The mean±SD age was 64.3±3.4 years, and the average time on study drug was 114 weeks. The NDD had a reduction in the stroke risk of 12% (RR=0.88, 95% CI 0.81-0.95, I²=29%) and a reduction in mortality risk of 13% (RR=0.87, 95% CI 0.81-0.93; I²=72%), relative to placebo. The average±SD least-squares mean differences for HbA1c levels were lower by 0.6± 0.3% for treatment group compared to placebo. In meta-regression analyses, HbA1c levels did not significantly affect stroke risk (β=-0.01, 95% CI -0.48-0.47).

Conclusions

NDD reduce the risk of stroke compared to placebo and this effect seems to be independent of HbA1c levels. Mortality risk had high heterogeneity, suggesting a need for carefully designed trials investigating the effect of NDD on stroke outcomes specifically.

Authors/Disclosures
Cecelia Barry, MD PRESENTER	Ms. Barry has nothing to disclose.
Gabriela Trifan, MD (UIC, Department of Neurology)	Dr. Trifan has nothing to disclose.
Fernando D. Testai, MD, PhD, FAAN (University of Illinois at Chicago)	Dr. Testai has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Testai has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Livingston, Barger, Brandt & Schroeder, L.L.P.. Dr. Testai has received publishing royalties from a publication relating to health care.

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