This target trial emulation using Swedish population data compared GLP-1 receptor agonists with DPP-4 inhibitors and SGLT2 inhibitors for heart failure hospitalization risk in type 2 diabetes, providing real-world comparative effectiveness data for cardiometabolic drug selection.
BACKGROUND:Novel treatments are needed for the primary and secondary prevention of heart failure in patients with type 2 diabetes, including individuals with and those without a history of heart failure. Conflicting trial evidence exists on whether glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce the risk of hospitalization for heart failure (HHF) in this broad population and whether this is a class effect or varies by specific agent. Furthermore, their comparative effectiveness against sodium-glucose cotransporter-2 inhibitors (SGLT-2is) is unknown.METHODS:We emulated 2 target trials using population-based health care data from Stockholm, Sweden (2010–2021). Target trial 1 included adult patients with type 2 diabetes who newly initiated GLP-1RA versus dipeptidyl peptidase-4 inhibitors (DPP-4is), and target trial 2 compared GLP-1RA with SGLT-2i. The primary outcome was HHF. Cox regression was used to estimate intention-to-treat hazard ratios, with inverse probability of trea
