Liraglutide's effect on stroke recurrence and vascular events in T2DM patients depends on insulin resistance

Acute ischemic stroke (AIS) is a major cause of death and disability. While GLP-1 receptor agonists (GLP-1RA) like liraglutide are known to reduce atherosclerotic events in Type 2 Diabetes and obesity, their direct efficacy and safety in the acute phase of minor stroke or high-risk transient ischemic attack (TIA) in T2DM patients remain less clear. Existing cardiovascular outcome trials suggest a modest reduction in incident stroke, but specific mechanisms and patient subgroups warrant further investigation.

This open-label, randomized active-comparator Phase 3 trial (NCT02043054) enrolled 636 patients with acute minor ischemic stroke (NIHSS ≤ 3) or high-risk TIA (ABCD2 score ≥ 4) and Type 2 Diabetes Mellitus. 510 patients (mean age 65 years, 64.7% male) were included in the 3-month follow-up analysis. The study aimed to assess the safety and efficacy of liraglutide against an active comparator, focusing on stroke recurrence and composite vascular events. Specific dosing for liraglutide was not detailed in the abstract.

A significant interaction between liraglutide treatment and insulin resistance was observed for both stroke recurrence and composite vascular events, with a P for interaction=0.02 for both outcomes. This indicates that the effect of liraglutide on preventing subsequent stroke and broader vascular events was not uniform across all patients but was significantly modulated by their baseline insulin resistance levels. The study followed patients for 3 months. No specific percentages of event reduction or absolute event rates were provided in the abstract for either stroke recurrence or composite vascular events. The abstract did not detail specific safety outcomes.