Investigators are building an empirical evidence base for real-world data through large-scale emulation of randomized controlled trials. The investigators' goal is to understand for what types of clinical questions real world data analyses can be conducted with confidence and how to implement such studies.
This is a non-randomized, non-interventional study that is part of the Randomized Controlled Trials Duplicated Using Prospective Longitudinal Insurance Claims: Applying Techniques of Epidemiology (RCT-DUPLICATE) initiative (www.rctduplicate.org) of the Brigham and Women's Hospital, Harvard Medical School. It is intended to assess the comparative effectiveness of 1. Tirzepatide vs dulaglutide, 2. Semaglutide vs sitagliptin, 3. Tirzepatide vs semaglutide on cardiovascular outcomes in individuals typically treated in clinical practice who are at cardiovascular risk with type 2 diabetes (T2DM) and overweight but might not meet the eligibility criteria of pivotal RCTs for each drug (SUSTAIN-6 and SURPASS-CVOT trials), used to support regulatory approval in patients at cardiovascular risk.Although many features of the target trials cannot be directly replicated in healthcare claims, key design features, including outcomes, exposures, and inclusion/exclusion criteria, were selected to proxy those features from the target trial. Randomization cannot be achieved in healthcare claims data but was proxied through a statistical balancing of measured covariates according to standard practice. The three database studies will be new-user active-comparative studies, conducted using 3 national United States claims databases, where investigators compare the effect of semaglutide vs sitagliptin (used as an active comparator placebo proxy), tirzepatide vs dulaglutide, and tirzepatide vs semaglutide on the composite end point of all-cause mortality, myocardial infarction, or stroke. Clinical guidelines during the study period recommended both tirzepatide and semaglutide for the same indications of glucose lowering and weight reduction.
Study Type
OBSERVATIONAL
Enrollment
887,132
New use of tirzepatide dispensing claim is used as the exposure.
New use of dulaglutide dispensing claim is used as the comparator.
New use of semaglutide dispensing claim is used as the exposure/comparator.
Brigham and Women's Hospital
Boston, Massachusetts, United States
Composite of all-cause mortality, myocardial infarction or stroke (Tirzepatide vs. dulaglutide)
To evaluate the comparative effect of tirzepatide vs dulaglutide on the composite of all-cause mortality, myocardial infarction, or death in patients typically treated in clinical practice who are at cardiovascular risk with type 2 diabetes and overweight.
Time frame: 1 day after cohort entry date until the first of outcome or censoring, up to 365 days
Composite of all-cause mortality, myocardial infarction or stroke (Injectable semaglutide vs sitagliptin)
To evaluate the comparative effect of injectable semaglutide vs sitagliptin on the composite of all-cause mortality, myocardial infarction, or death in patients typically treated in clinical practice who are at cardiovascular risk with type 2 diabetes and overweight.
Time frame: 1 day after cohort entry date until the first of outcome or censoring, up to 365 days
Composite of all-cause mortality, myocardial infarction or stroke (Tirzepatide vs injectable semaglutide)
To evaluate the comparative effect of tirzepatide vs semaglutide on the composite of all-cause mortality, myocardial infarction, or death in patients typically treated in clinical practice who are at cardiovascular risk with type 2 diabetes and overweight.
Time frame: 1 day after cohort entry date until the first of outcome or censoring, up to 365 days
Individual components of the primary endpoint, i.e., all-cause mortality, myocardial infarction, or stroke (Tirzepatide vs dulaglutide)
To evaluate the comparative effect of tirzepatide vs dulaglutide on the individual components of the primary endpoint, i.e., all-cause mortality, myocardial infarction, or stroke in patients typically treated in clinical practice who are at cardiovascular risk with type 2 diabetes and overweight.
Time frame: 1 day after cohort entry date until the first of outcome or censoring, up to 365 days
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
New use of sitagliptin dispensing claim is used as the comparator.
Composite of all-cause mortality, hospitalization for heart failure, or urgent heart failure visits requiring intravenous diuretics (Tirzepatide vs dulaglutide)
To evaluate the comparative effect of tirzepatide vs dulaglutide on all-cause mortality, hospitalization for heart failure, or urgent heart failure visits in patients typically treated in clinical practice who are at cardiovascular risk with type 2 diabetes and overweight.
Time frame: 1 day after cohort entry date until the first of outcome or censoring, up to 365 days
Urinary tract infections (Tirzepatide vs dulaglutide)
To evaluate the comparative effect of tirzepatide vs dulaglutide on the safety outcome of urinary tract infections in patients typically treated in clinical practice who are at cardiovascular risk with type 2 diabetes and overweight.
Time frame: 1 day after cohort entry date until the first of outcome or censoring, up to 365 days
Serious bacterial infections (Tirzepatide vs dulaglutide)
To evaluate the comparative effect of tirzepatide vs dulaglutide on the safety outcome of serious bacterial infections in patients typically treated in clinical practice who are at cardiovascular risk with type 2 diabetes and overweight.
Time frame: 1 day after cohort entry date until the first of outcome or censoring, up to 365 days
Gastrointestinal adverse events (Tirzepatide vs dulaglutide)
To evaluate the comparative effect of tirzepatide vs dulaglutide on the safety outcome of gastrointestinal adverse events in patients typically treated in clinical practice who are at cardiovascular risk with type 2 diabetes and overweight.
Time frame: 1 day after cohort entry date until the first of outcome or censoring, up to 365 days
Individual components of the primary endpoint, i.e., all-cause mortality, myocardial infarction, or stroke (Injectable semaglutide vs sitagliptin)
To evaluate the comparative effect of injectable semaglutide vs sitagliptin on the individual components of the primary endpoint, i.e., all-cause mortality, myocardial infarction, or stroke in patients typically treated in clinical practice who are at cardiovascular risk with type 2 diabetes and overweight.
Time frame: 1 day after cohort entry date until the first of outcome or censoring, up to 365 days
Composite of all-cause mortality, hospitalization for heart failure, or urgent heart failure visits requiring intravenous diuretics (Injectable semaglutide vs sitagliptin)
To evaluate the comparative effect of injectable semaglutide vs sitagliptin on all-cause mortality, hospitalization for heart failure, or urgent heart failure visits in patients typically treated in clinical practice who are at cardiovascular risk with type 2 diabetes and overweight.
Time frame: 1 day after cohort entry date until the first of outcome or censoring, up to 365 days
Urinary tract infections (Injectable semaglutide vs sitagliptin)
To evaluate the comparative effect of injectable semaglutide vs sitagliptin on the safety outcome of urinary tract infections in patients typically treated in clinical practice who are at cardiovascular risk with type 2 diabetes and overweight.
Time frame: 1 day after cohort entry date until the first of outcome or censoring, up to 365 days
Serious bacterial infections (Injectable semaglutide vs sitagliptin)
To evaluate the comparative effect of injectable semaglutide vs sitagliptin on the safety outcome of serious bacterial infections in patients typically treated in clinical practice who are at cardiovascular risk with type 2 diabetes and overweight.
Time frame: 1 day after cohort entry date until the first of outcome or censoring, up to 365 days
Gastrointestinal adverse events (Injectable semaglutide vs sitagliptin)
To evaluate the comparative effect of injectable semaglutide vs sitagliptin on the safety outcome of gastrointestinal adverse events in patients typically treated in clinical practice who are at cardiovascular risk with type 2 diabetes and overweight.
Time frame: 1 day after cohort entry date until the first of outcome or censoring, up to 365 days
Individual components of the primary endpoint, i.e., all-cause mortality, myocardial infarction, or stroke (Tirzepatide vs injectable semaglutide)
To evaluate the comparative effect of tirzepatide vs injectable semaglutide on the individual components of the primary endpoint, i.e., all-cause mortality, myocardial infarction, or stroke in patients typically treated in clinical practice who are at cardiovascular risk with type 2 diabetes and overweight.
Time frame: 1 day after cohort entry date until the first of outcome or censoring, up to 365 days
Composite of all-cause mortality, hospitalization for heart failure, or urgent heart failure visits requiring intravenous diuretics (Tirzepatide vs injectable semaglutide)
To evaluate the comparative effect of tirzepatide vs injectable semaglutide on all-cause mortality, hospitalization for heart failure, or urgent heart failure visits in patients typically treated in clinical practice who are at cardiovascular risk with type 2 diabetes and overweight.
Time frame: 1 day after cohort entry date until the first of outcome or censoring, up to 365 days
Urinary tract infections (Tirzepatide vs injectable semaglutide)
To evaluate the comparative effect of tirzepatide vs injectable semaglutide on the safety outcome of urinary tract infections in patients typically treated in clinical practice who are at cardiovascular risk with type 2 diabetes and overweight.
Time frame: 1 day after cohort entry date until the first of outcome or censoring, up to 365 days
Serious bacterial infections (Tirzepatide vs injectable semaglutide)
To evaluate the comparative effect of tirzepatide vs injectable semaglutide on the safety outcome of serious bacterial infections in patients typically treated in clinical practice who are at cardiovascular risk with type 2 diabetes and overweight.
Time frame: 1 day after cohort entry date until the first of outcome or censoring, up to 365 days
Gastrointestinal adverse events (Tirzepatide vs injectable semaglutide)
To evaluate the comparative effect of tirzepatide vs injectable semaglutide on the safety outcome of gastrointestinal adverse events in patients typically treated in clinical practice who are at cardiovascular risk with type 2 diabetes and overweight.
Time frame: 1 day after cohort entry date until the first of outcome or censoring, up to 365 days