Cited by 2,409Diabetes Treatment and ManagementDiabetes, Cardiovascular Risks, and LipoproteinsHeart Failure Treatment and Management

Lixisenatide in Patients with Type 2 Diabetes and Acute Coronary Syndrome

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Pfeffer, Marc A., Claggett, Brian, Diaz, Rafael, Dickstein, Kenneth, Gerstein, Hertzel C., Køber, Lars V., Lawson, Francesca C., Ping, Lin +8 more·2015·New England Journal of Medicine

Abstract

BACKGROUND: Cardiovascular morbidity and mortality are higher among patients with type 2 diabetes, particularly those with concomitant cardiovascular diseases, than in most other populations. We assessed the effects of lixisenatide, a glucagon-like peptide 1-receptor agonist, on cardiovascular outcomes in patients with type 2 diabetes who had had a recent acute coronary event. METHODS: We randomly assigned patients with type 2 diabetes who had had a myocardial infarction or who had been hospitalized for unstable angina within the previous 180 days to receive lixisenatide or placebo in addition to locally determined standards of care. The trial was designed with adequate statistical power to assess whether lixisenatide was noninferior as well as superior to placebo, as defined by an upper boundary of the 95% confidence interval for the hazard ratio of less than 1.3 and 1.0, respectively, for the primary composite end point of cardiovascular death, myocardial infarction, stroke, or hospitalization for unstable angina. RESULTS: The 6068 patients who underwent randomization were followed for a median of 25 months. A primary end-point event occurred in 406 patients (13.4%) in the lixisenatide group and in 399 (13.2%) in the placebo group (hazard ratio, 1.02; 95% confidence interval [CI], 0.89 to 1.17), which showed the noninferiority of lixisenatide to placebo (P<0.001) but did not show superiority (P=0.81). There were no significant between-group differences in the rate of hospitalization for heart failure (hazard ratio in the lixisenatide group, 0.96; 95% CI, 0.75 to 1.23) or the rate of death (hazard ratio, 0.94; 95% CI, 0.78 to 1.13). Lixisenatide was not associated with a higher rate of serious adverse events or severe hypoglycemia, pancreatitis, pancreatic neoplasms, or allergic reactions than was placebo. CONCLUSIONS: In patients with type 2 diabetes and a recent acute coronary syndrome, the addition of lixisenatide to usual care did not significantly alter the rate of major cardiovascular events or other serious adverse events. (Funded by Sanofi; ELIXA ClinicalTrials.gov number, NCT01147250.).

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Crossref · 10.1056/nejmoa1509225

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  • In the ELIXA trial, the GLP-1 receptor agonist lixisenatide did not show any cardiovascular benefit in patients with diabetes and a recent acute coronary syndrome.

    “in the Evaluation of Lixisenatide in Acute Coronary Syndrome (ELIXA) trial,14 the GLP-1–receptor agonist lixisenatide, which is shorter-acting than and structurally dissimilar to liraglutide, did not show any cardiovascular benefit in patients with diabetes and a recent acute coronary syndrome.”

    From Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes (2016) · cites this paper as [14]

  • No increased risk of heart failure hospitalization has been identified in the cardiovascular outcomes trials of the GLP-1 RAs lixisenatide, liraglutide, semaglutide, exenatide once weekly, albiglutide, or dulaglutide compared with placebo.

    “No increased risk of heart failure hospitalization has been identified in the cardiovascular outcomes trials of the GLP-1 RAs lixisenatide, liraglutide, semaglutide, exenatide once weekly, albiglutide, or dulaglutide compared with placebo (261,264,265,296,297).”
  • In the Harmony Outcomes, EXSCEL, and AMPLITUDE-O cardiovascular outcome trials, there were numerically fewer strokes, but the hazard ratios were not significant.

    “In the CVOTs Harmony Outcomes (albiglutide vs placebo), EXSCEL (exenatide LA vs placebo), and AMPLITUDE-O (efpeglenatide vs placebo), there were numerically fewer strokes, but HRs were not significant.472,641,644”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [641]

    The Cardiovascular End Points section (p. 2252) reports stroke outcomes for lixisenatide versus placebo, not for Harmony Outcomes, EXSCEL, or AMPLITUDE-O. Searches for those trial names and their drugs found no passage in our copy addressing their stroke counts or hazard ratios. (LLM, conf=0.77)

    Experimental — accuracy not yet measured
  • In the ELIXA trial, lixisenatide is not inferior, although not superior, to placebo in cardiovascular safety.

    “The study showed that lixisenatide is not inferior, although not superior, to placebo in cardiovascular safety.”
  • LIXI effectively reduces glycosylated hemoglobin levels in T2DM patients by reducing fasting and postprandial blood glucose levels.

    “The indication is to effectively reduce glycosylated hemoglobin levels in patients with T2DM by reducing fasting and postprandial blood glucose levels (61, 62).”

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Authors
Pfeffer, M. A., Claggett, B., Diaz, R., Dickstein, K., Gerstein, H. C., Køber, L. V., Lawson, F. C., Ping, L., Wei, X., Lewis, E. F., Maggioni, A. P., McMurray, J. J. V., Probstfield, J. L., Riddle, M. C., Solomon, S. D., & Tardif, J.-C.
Affiliations
  • Brigham and Women's Hospital (US)
  • Stavanger University Hospital (NO)
  • McMaster University (CA)
  • Copenhagen University Hospital (DK)
  • Sanofi (United States) (US)
  • University of Zurich (CH)
  • University of Washington Medical Center (US)
  • Oregon Health & Science University (US)
  • Montreal Heart Institute (CA)
Venue
New England Journal of Medicine
Published
2015-12-03
Volume
373
Issue
23
Pages
2247-2257
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2282578582
Cited by
2,409
References
38
Citations by year
2026: 136 · 2025: 175 · 2024: 182 · 2023: 165 · 2022: 191 · 2021: 250 · 2020: 281 · 2019: 251 · 2018: 290 · 2017: 278 · 2016: 202 · 2015: 4 · 2013: 1
FWCI
224.29
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
  • Research Bank (Australian Catholic University) (submittedVersion)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
  • Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion, other-oa)
  • Oskar-Bordeaux (Universite de Bordeaux) (submittedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
  • Research Explorer (The University of Manchester) (submittedVersion)
  • VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
  • Zurich Open Repository and Archive (University of Zurich)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Keywords
lixisenatide, type 2 diabetes, acute coronary syndrome, myocardial infarction, unstable angina, GLP-1 receptor agonists, cardiovascular outcomes, non-inferiority, major adverse cardiovascular events, heart failure hospitalization, serious adverse events, hypoglycemia, pancreatitis, pancreatic neoplasms, allergic reactions
MeSH terms
Glucagon-Like Peptide-1 Receptor, Glucagon-Like Peptide-2 Receptor, Glucagon-Like Peptide-1 Receptor Agonists, Aged, Angina, Unstable, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Male, Middle Aged, Myocardial Infarction, Peptides, Proportional Hazards Models, Treatment Failure, Kaplan-Meier Estimate, Acute Coronary Syndrome

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