Effect of SGLT2 inhibitor Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction
SGLT2 inhibitors possess a unique mechanism of lowering glucose independent of
the insulin pathway thereby establishing their role in the treatment of diabetes.
Especially in patients with type 2 diabetes who are not willing or not ready to
start insulin, SGLT2 inhibitors may be another option in those patients requiring
additional glucose lowering and in those with acceptable risk factor profiles.
In a multicentered, randomized placebo controlled trial on the efficacy check
of dapagliflozin, 4744 patients with heart failure and an ejection fraction of
40% or less were assigned to receive either dapagliflozin at a dose of 10 mg o
nce daily or placebo, in addition to standard heart failure therapy. The primary
outcome was a composite of worsening heart failure or cardiovascular deaths.
Over a period of 18.2 month median follow-up, the primary outcome occurred in
386 of 2373 patients (16.3%) in the dapagliflozin group and in 502 of 2371
patients (21.2%) in the placebo group. A first worsening heart failure event
occurred in 237 patients (10.0%) in the dapagliflozin group and in 326 patients
(13.7%) in the placebo group. Death from cardiovascular causes occurred in 227
patients (9.6%) in the dapagliflozin group and in 273 patients (11.5%) in the
placebo group. Findings in patients with diabetes were similar to those in
patients without diabetes. The safety measurement was evaluated with the frequency
of adverse events related to volume depletion, renal dysfunction, and hypoglycemia.
It was observed that these adverse outcomes did not differ between the treatment groups.
The authors concluded that in patients with heart failure and less ejection
fraction dapagliflozin reduced the risk of worsening heart failure and cardiovascular
deaths. The observation was found to be similar in patients without diabetes too.