New approach emerges for treating HF patients with and without diabetes

Patients with heart failure and reduced ejection fraction (HFrEF) are well served by treatment with the glucose-lowering drug dapagliflozin, as it warded off death and hospitalization while also improving quality of life when added to standard care regimens in a major trial.

The good outcomes were consistent across cohorts of patients with and without diabetes. Moreover, tolerability was high and safety events few even in elderly patients.

These latest results of the widely followed trial, DAPA-HF, for Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure, were presented over the weekend at the American Heart Association’s annual meeting in Philadelphia and are running in two study reports published Nov. 17 in Circulation.

In one study, lead author Mikhail Kosiborod, MD, of Saint Luke’s Health System in Kansas City and colleagues found the drug treatment corresponded with clinically important improvements over baseline metrics in HFrEF patients as well as small, moderate and substantial boosts in health status.

In the other, senior author John McMurray, MD, of BHF Glasgow Cardiovascular Research Centre in Scotland and colleagues found dapagliflozin cut the risks of death and worsening heart failure while also reducing symptoms across a broad range of patient ages.

In a brief video commentary posted by the AHA, McMurray underscores that dapagliflozin was very well tolerated compared to placebo. Further, in patients without diabetes, “we saw no evidence of hypoglycemia … and no cases of diabetic ketoacidosis.”

The new findings follow close on the heels of an announcement from AstraZeneca that its dapagliflozin product, a sodium-glucose cotransporter 2 (SGLT2) inhibitor that the company markets as Farxiga, won approval from the FDA for reducing hospitalization risk in adult heart-failure patients with type 2 diabetes.

McMurray et al. concluded that dapagliflozin “offers a new approach” to the treatment of HFrEF in patients with and without type 2 diabetes.