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Message: Re: Statistical Considerations
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Mar 07, 2018 10:57AM
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Mar 08, 2018 03:47PM

Mar 08, 2018 07:06PM
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Nextblockbuster,

I don't know about past trials and 5-point MACE. In recently completed cardiovascular outcomes trials in diabetes patients, 5-point MACE is not a common primary outcome. 3-point MACE seems to be the standard. Various cardiovascular outcomes trials in diabetic patients have been completed (with many still ongoing) for DPP4-inhibitors, GLP1-R agonists, and SGLT2 inhibitors. As detailed in those references I posted in my previous post, the only ones to show cardiovascular benefit (3-point MACE reduction) so far are the SGLT2 inhibitors and GLP1-R agonists. 

Two SGLT2 inhibitors canagliflozin and empagliflozin both elicited a 14% RRR in 3-point MACE. Empagliflozin results were primarily driven by 38% reduction in cardiovascular death, whereas canagliflozin results were due to more modest reductions in each of the 3-point MACE components. Dopagliflozin and ertugliflozin still have ongoing CVOT trials with readouts due in 2019 I believe.

http://www.nejm.org/doi/full/10.1056/NEJMoa1611925

http://www.nejm.org/doi/full/10.1056/NEJMoa1504720

Two GLP1-R agonists trials have also been shown to reduce cardiovasciular events. Liraglutide had a 14% RRR in 3-point MACE, primarily driven by significant 22% reduction in CV death. Semaglutide achieved a 26% RRR in 3-point MACE due to reductions in non-fatal MI and stroke but no effect on CV death. Dulaglutide and Albiglutide still have ongoing CVOT trials with readouts due in 2019 I believe.

http://www.nejm.org/doi/full/10.1056/NEJMoa1603827

http://www.nejm.org/doi/full/10.1056/NEJMoa1607141

 

 

 

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