Abstract 4145444: GLP-1 Receptor Agonists And Clinical Events After Anthracycline-Based Chemotherapy: A Propensity Score-Matched Cohort Study

Introduction: Anthracyclines are associated with cancer therapy-related cardiovascular dysfunction and heart failure (HF). The role of GLP-1 receptor agonists for patients with cancer undergoing anthracycline-based chemotherapy remains unknown. Hypothesis: GLP-1 receptor agonists are associated with reduced mortality and cardiovascular events after chemotherapy with anthracyclines. Aims: Evaluate the association between GLP-1-treated patients undergoing chemotherapy with anthracyclines and mortality and cardiovascular events. Methods: We conducted a retrospective cohort study of de-identified, aggregated data from 120 centers using the TriNetX Global Collaborative Network. Patients with ≥18 years old, a diagnosis of cancer, a history of use of anthracyclines, and either type 2 diabetes mellitus or overweight/obesity were included. We excluded patients with end-stage kidney disease, ischemic heart disease, or aortocoronary bypass graft. Patients were stratified according to treatment with GLP-1 receptor agonists or not and underwent propensity score matching. We compared HF exacerbation, hospitalizations or urgent emergency department visits, and all-cause mortality rates using Cox proportional hazard models over an 8-year follow-up. Results: After propensity score matching, 2,575 patients remained in each cohort. At 8 years, GLP-1 use was associated with significantly lower rates of HF exacerbation, defined as the need for diuretics, pulmonary edema, systolic and/or diastolic acute decompensated HF, or reaching a left ventricular ejection fraction <40% (HR 0.49; 95% CI 0.42–0.57; p<0.001; Fig. 1A). In addition, GLP-1 use was also associated with lower rates of hospitalizations or urgent emergency department visits (HR 0.45; 95% CI 0.35–0.58; p<0.001; Fig. 1B) and all-cause mortality (HR 0.43; 95% CI 0.38–0.49; p<0.001; Fig. 1C). Conclusion: In this propensity score-matched cohort study comprising 5,150 patients with obesity or type 2 diabetes mellitus undergoing chemotherapy with anthracyclines, the use of GLP-1 receptor agonists was associated with lower incidences of HF exacerbation, hospitalizations, and mortality.