Effect of glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors on colorectal cancer incidence and its precursors

Incretin-based antihyperglycemic therapies increase intestinal mucosal expansion and polyp growth in mouse models. We aimed to evaluate the effect of dipeptidyl peptidase-4 inhibitors (DPP-4i) or glucagon-like peptide-1 receptor agonists (GLP-1ra) initiation on colorectal cancer incidence

Cardiovascular Effectiveness of Sodium‐Glucose Cotransporter 2 Inhibitors and Glucagon‐Like Peptide‐1 Receptor Agonists in Older Patients in Routine Clinical Care With or Without History of Atherosclerotic Cardiovascular Diseases or Heart Failure

Background Randomized trials demonstrate the cardioprotective effects of sodium‐glucose cotransporter 2 inhibitors (SGLT2i) and glucagon‐like peptide‐1 receptor agonists (GLP‐1RA). We evaluated their relative cardiovascular effectiveness in routine care populations with a broad spectrum of atherosclerotic cardiovascular diseases (CVDs) or heart failure (HF). Methods and Results We identified Medicare beneficiaries from 2013 to 2017, aged >65 years, initiating SGLT2i (n=24 747) or GLP‐1RA (n=22 596) after a 1‐year baseline. On the basis of diagnoses during baseline, we classified patients into: (1) no HF or CVD, (2) HF but no CVD, (3) no HF but CVD, and (4) both HF and CVD. We identified hospitalized HF and atherosclerotic CVD outcomes from drug initiation until treatment changes, death, or disenrollment. We estimated propensity score–weighted 2‐year risk ratios (RRs) and risk differences, accounting for measured confounding, informative censoring, and competing risk. In patients with no CVD or HF, SGLT2i reduced the hospitalized HF risk compared with GLP‐1RA (propensity score–weighted RR, 0.65; 95% CI, 0.43–0.96). The association was strongest in those who had HF but no CVD (RR, 0.48; 95% CI, 0.25–0.85). The combined myocardial infarction, stroke, and mortality outcome risk was slightly higher for SGLT2i compared with GLP‐1RA in those without CVD or HF (RR, 1.31; 95% CI, 1.09–1.56). The association was favorable toward SGLT2i in subgroups with a history of HF. Conclusions SGLT2i reduced the cardiovascular risk versus GLP‐1RA in patients with a history of HF but no CVD. Atherosclerotic CVD events were less frequent with GLP‐1RA in those without prior CVD or HF

Effect of glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors on colorectal cancer incidence and its precursors

AIMS: Incretin-based antihyperglycemic therapies increase intestinal mucosal expansion and polyp growth in mouse models. We aimed to evaluate the effect of dipeptidyl peptidase-4 inhibitors (DPP-4i) or glucagon-like peptide-1 receptor agonists (GLP-1ra) initiation on colorectal cancer incidence. METHODS: We conducted a cohort study on US Medicare beneficiaries over age 66 from 2007-2013 without prevalent cancer. We identified three active-comparator and new-user cohorts: DPP-4i versus thiazolidinediones (TZD), DPP-4i versus sulphonylureas (SU), and GLP-1ra versus long acting insulin (LAI). Follow-up started from six months post second prescription and ended six months after stopping (primary as-treated analysis). We estimated hazard ratios (HR) and 95% confidence intervals (CI) for incident colorectal cancer adjusting for measured confounders using propensity score weighting. RESULTS: The median duration of treatment ranged 0.7-0.9 years among DPP-4i cohorts. Based on 104 events among 39,334 DPP-4i and 63 events among 25,786 TZD initiators, there was no association between DPP-4i initiation and colorectal cancer (adjusted HR=1.17 (CI: 0.88, 1.71)). There were 73 events among 27,047 DPP-4i and 266 events among 76,012 SU initiators with the adjusted HR: 0.98 (CI: 0.74, 1.30). We identified 5,600 GLP-1ra and 54,767 LAI initiators and the median duration of treatment was 0.8 and 1.2 years, respectively. The adjusted HR was 0.82 (CI: 0.42, 1.58) based on <11 events among GLP-1ra versus 276 events among LAI initiators. CONCLUSION: Although limited by the short duration of treatment, our analyses based on real world drug utilization patterns provide evidence of no short-term effect of incretin-based agents on colorectal cancer

COVID-19 Pandemic Impact on Public Distress, Economy and Education of Bago Division in Myanmar

In Myanmar, two expatriates have started infected by COVID-19 pandemic on 23 March in 2020 and COVID-19 period was divided into the two periods by the data of patients, from starting July 29, no more infected people found till August 19. Myanmar citizen think that there will be no more new COVID-19 cases, they started running their daily work, not following precaution methods. Unfortunately, the number of patients increased more and more, starting from 20th August. The period between 23rd March and 19th August was regarded as COVID-19 first wave and the period starting from 10th August was COVID-19 second wave by Government. In Myanmar, numbers of developed city are fewer than rural townships. Infrastructures of townships are same and most people, living in rural townships are not rich and they didn't have saving money in Banks and they are depending on their monthly salaries. During pandemic period, general workers faced with unemployment problem and difficulty in daily expenses. Some volunteers helped daily expenses to poor people in COVID-19 first wave. In second COVID-19 wave, volunteers cannot help many families. This paper focused on COVID-19 pandemic impact on Public psychological consequences, Economy, Educational dimension and the prospects after pandemic

Additional file 1 of Cardiorenal effectiveness of empagliflozin vs. glucagon-like peptide-1 receptor agonists: final-year results from the EMPRISE study

Supplementary Material