GLORIOUS: GLP-1 agonist did not meet primary endpoint in CABG

Exenatide did not reduce mortality or severe organ injury among patients who underwent cardiopulmonary bypass (CPB)-assisted coronary artery bypass grafting (CABG) and/or aortic valve replacement, as indicated by the results from the GLORIOUS trial.

Dr Sebastian Wiberg (Rigshospitalet Copenhagen University, Denmark) and colleagues tested the applicability of the glucagon-like peptide-1 (GLP-1) agonist exenatide in patients who underwent CPB-assisted CABG and/or aortic valve replacement [1]. They hypothesised that a perioperative 6-hour and 15-minute infusion of 17.4 μg of exenatide, initiated after anaesthesia but prior to surgery, would reduce mortality and organ injury compared with placebo. The GLORIOUS trial (NCT02673931) randomised 1,389 participants 1:1 to exenatide or a placebo and simultaneously tested a restrictive versus liberal oxygenation strategy. The primary endpoint was a composite of death, stroke, renal failure, and heart failure.

After a median follow-up of 5.9 years, no difference was observed between the study arms in the time to first occurring sub-endpoint (HR 1.0; 95% CI 0.83–1.30; P=0.80). Likewise, the investigators did not see any differences between the study arms with respect to adverse events. “In the subgroup analysis, we did see that patients with ‘known stroke’ may benefit from exenatide,” mentioned Dr Wiberg. “This is, however, only hypothesis-generating data.”

“We are currently enrolling 1,200 patients undergoing CPB-assisted heart surgery to randomise them to the same 4 different interventions in the GLORIOUS II trial,” Dr Wiberg concluded his talk.

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   1. Wiberg S, et al. Efficacy of the glucagon-like peptide-1 agonist exenatide in patients undergoing coronary artery bypass grafting or aortic valve replacement. LBS.04, AHA Scientific Sessions 2024, 16–18 November, Chicago, USA.

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Posted on 3 February 2025