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In combination with glimepiride, with or without metformin, the overall incidence of clinical adverse reactions with JANUVIA was higher than with placebo, in part related to a higher incidence of hypoglycemia (see Table 3)

placebo in the fall of eGFR was better among patients with macroalbuminuria or in those with eGFR between 3060 ml/min/1.73 m2,100 and in the AWARD-7 trial the effect of dulaglutide on renal clinical outcomes and eGFR decline was more pronounced in participants with macroalbuminuria at baseline.66 Likewise, in a post hoc analysis of the LEADER study those patients who experienced a 30% reduction in albuminuria during follow-up had fewer cardiovascular and renal events,101 which confirms that a reduction in albuminuria is associated with a reduction in cardiovascular and renal events.99,102 Finally, the renal benefits of arGLP-1 appear to be additive to those of iSGLT2, which is of particular interest in patients with DKD.85,86,103 Cardiovascular and renal benefits of these drugs have been also demonstrated in real-life studies.104105 The causes of renal protection by some arGLP-1 s are unclear

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Figure 1 2.2.2 Attenuation of inflammatory response Neuroinflammation is a key pathological mechanism in neurodegenerative diseases and has been strongly implicated in PD