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Background <p>Glucagon-like peptide-1 receptor agonists (GLP-1As) have been shown to be beneficial in primary stroke prevention for high-risk patients. However, their benefits following major ischemic events are unclear. Herein, we present real-world analysis assessing outcomes of GLP-1A following major ischemic event.</p> Methods <p>This retrospective cohort study utilized the TriNetX platform. Adults (≥ 18&#xa0;years) with AIS treated with intravenous thrombolysis (IVT) were identified; exposure was any US FDA-approved GLP-1A initiated within 6&#xa0;months of the index stroke. The comparator was IVT-treated patients without GLP-1A exposure. Outcomes assessed at 5&#xa0;years included major adverse health-care events (MAHEs): number of emergency department (ED) visits and inpatient hospitalizations, and all-cause mortality. One-to-one propensity score matching balanced baseline characteristics. We estimated risk difference/risk ratio/odds ratio, 5-year Kaplan–Meier (KM) event probabilities with log-rank tests, and Cox hazard ratios (HRs) with 95% CIs; small cells (≤ 10) were masked per data-use agreement.</p> Results <p>Of 69,005 eligible patients, 549 received GLP-1A and 68,938 did not; after matching, 432 per group were analyzed. GLP-1A exposure was associated with lower all-cause mortality (7.4% vs 14.1%; HR 0.61, 95% CI 0.39–0.93), lower ED visits (37% vs 47%; HR 0.78, 95% CI 0.63–0.95), and lower inpatient hospitalizations (31.9% vs 45.4%; HR 0.69, 95% CI 0.55–0.85); KM log-rank <i>p</i> ≤ 0.05 for all. Median time to first MAHE was longer with GLP-1A (1293 vs 897&#xa0;days for hospitalization and 886 vs 603&#xa0;days for ED visits).</p> Conclusions <p>GLP-1A therapy after IVT is associated with favorable long-term safety and utilization signals and warrants confirmation in a prospective study with standardized initiation.</p>

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Outcomes of GLP-1 receptor agonist use following ischemic stroke: a propensity score-matched real-world analysis

  • 期刊论文

  • 发表日期：

    2025年10月21日

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  • Pranjal Rai,
  • Girish Bathla,
  • Niharika Praveen,
  • Shreya Sri Gopikonda,
  • Huanwen Alvin Chen,
  • Hamza A. Salim,
  • Ahmed Azzam,
  • Muhammed Amir Essibayi,
  • David J. Altschul,
  • Adam A. Dmytriw,
  • Vivek S. Yedavalli,
  • Shahrzad Latifi,
  • Ajay Malhotra,
  • Marco Colasurdo,
  • Dheeraj Gandhi,
  • Dhairya A. Lakhani

摘要

Background

Glucagon-like peptide-1 receptor agonists (GLP-1As) have been shown to be beneficial in primary stroke prevention for high-risk patients. However, their benefits following major ischemic events are unclear. Herein, we present real-world analysis assessing outcomes of GLP-1A following major ischemic event.

Methods

This retrospective cohort study utilized the TriNetX platform. Adults (≥ 18 years) with AIS treated with intravenous thrombolysis (IVT) were identified; exposure was any US FDA-approved GLP-1A initiated within 6 months of the index stroke. The comparator was IVT-treated patients without GLP-1A exposure. Outcomes assessed at 5 years included major adverse health-care events (MAHEs): number of emergency department (ED) visits and inpatient hospitalizations, and all-cause mortality. One-to-one propensity score matching balanced baseline characteristics. We estimated risk difference/risk ratio/odds ratio, 5-year Kaplan–Meier (KM) event probabilities with log-rank tests, and Cox hazard ratios (HRs) with 95% CIs; small cells (≤ 10) were masked per data-use agreement.

Results

Of 69,005 eligible patients, 549 received GLP-1A and 68,938 did not; after matching, 432 per group were analyzed. GLP-1A exposure was associated with lower all-cause mortality (7.4% vs 14.1%; HR 0.61, 95% CI 0.39–0.93), lower ED visits (37% vs 47%; HR 0.78, 95% CI 0.63–0.95), and lower inpatient hospitalizations (31.9% vs 45.4%; HR 0.69, 95% CI 0.55–0.85); KM log-rank p ≤ 0.05 for all. Median time to first MAHE was longer with GLP-1A (1293 vs 897 days for hospitalization and 886 vs 603 days for ED visits).

Conclusions

GLP-1A therapy after IVT is associated with favorable long-term safety and utilization signals and warrants confirmation in a prospective study with standardized initiation.