SURPASS-4 (post-hoc analysis)
Trial question
Is tirzepatide superior to insulin glargine in patients with T2DM with regard to renal outcomes?
Study design
Multi-center
Open label
RCT
Population
1995 patients.
Inclusion criteria: adult patients with inadequately controlled T2DM on oral diabetes medication and high cardiovascular risk.
Key exclusion criteria: T1DM mellitus, chronic or acute pancreatitis, acute or chronic hepatitis, diabetic retinopathy requiring urgent treatment, heart attack or stroke in the past 2 months.
Interventions
N=995 tirzepatide (initiated at 2.5 mg SC once weekly and increased by 2.5 mg every 4 weeks until the randomly assigned maintenance dose of 5 mg, 10 mg, or 15 mg once weekly was reached, and continued for a total of 104 weeks).
N=1000 insulin glargine (titrated to 100 U/mL SC once daily).
Primary outcome
Estimated glomerular filtration decline
1.4
3.6
3.6 mL/min/1.73m²
2.7 mL/min/1.73m²
1.8 mL/min/1.73m²
0.9 mL/min/1.73m²
0.0 mL/min/1.73m²
Tirzepatide
Insulin
glargine
Significant
decrease ▼
Significant decrease in estimated glomerular filtration decline (1.4 mL/min/1.73 m² vs. 3.6 mL/min/1.73 m²; AD -2.2 mL/min/1.73 m², 95% CI -1.6 to -2.8).
Secondary outcomes
Significant increase in urine albumin-creatinine ratio reduction (6.8% vs. -36.9%; AD 31.9%, 95% CI 25.7 to 37.7).
Conclusion
In adult patients with inadequately controlled T2DM on oral diabetes medication and high cardiovascular risk, tirzepatide was superior to insulin glargine with respect to estimated glomerular filtration decline.
Reference
Hiddo J L Heerspink, Naveed Sattar, Imre Pavo et al. Effects of tirzepatide versus insulin glargine on kidney outcomes in type 2 diabetes in the SURPASS-4 trial: post-hoc analysis of an open-label, randomised, phase 3 trial. Lancet Diabetes Endocrinol. 2022 Nov;10(11):774-785.
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