Glucagon-like peptide-1 receptor agonists in patients with moyamoya disease and type 2 diabetes mellitus

OBJECTIVE: Moyamoya disease (MMD) is a chronic occlusive cerebrovascular disease that is commonly associated with comorbidities such as type 2 diabetes mellitus (T2DM). Glucagon-like peptide-1 (GLP-1) receptor agonists are antihyperglycemic agents that have demonstrated the ability to reduce stroke. The aim of this study was to analyze the role of GLP-1 receptor agonists in the treatment of patients with MMD and T2DM by comparing those with and without GLP-1 agonist therapy. METHODS: Patients with MMD and T2DM were retrospectively identified from the TriNetX research network and subsequently dichotomized into those who were prescribed GLP-1 receptor agonists and those who were not. Propensity score matching (PSM) was performed to estimate the effect of GLP-1 treatment. Kaplan-Meier survival curves were used to analyze outcomes of interest, which were stroke, intracerebral hemorrhage (ICH), and death. RESULTS: Of 2770 patients, 476 (17.2%) had a history of GLP-1 receptor agonist usage. Of 2294 (82.8%) who did not have a history of GLP-1 receptor agonist usage, 2272 were included. PSM resulted in 413 patients in each group. Patients with MMD and T2DM who received GLP-1 receptor agonists had 33% lower risk of stroke (HR 0.67, 95% CI 0.55-0.81; p < 0.001), 71% lower risk of ICH (HR 0.29, 95% CI 0.15-0.58; p < 0.001), and 66% lower risk of death (HR 0.34, 95% CI 0.21-0.56; p < 0.001) compared with patients with MMD and T2DM who did not receive GLP-1 agonists. CONCLUSIONS: In this study, patients with MMD and T2DM who were prescribed a GLP-1 receptor agonist had lower risk of stroke, ICH, and death. Prospective studies and randomized controlled trials are needed to clarify the role of GLP-1 receptor agonists in the management of MMD.