Abbreviations

SGLT2: Sodium-Glucose Cotransporter 2 Inhibitors; FDA: Food And Drug Administration; MACE: Major Adverse Cardiovascular Events; HFREF: Heart Failure With Reduced Ejection Fraction; ICD: Implantable Cardioverter Defibrillator; CRT: ACC/AHA/HFSA: Cardiac Resynchronization Therapy; American College Of Cardiology/American Heart Association/Heart Failure Society Of America; HFPEF: Heart Failure With Preserved Ejection Fraction.

  The recently published trial, the DAPA-HF trial, advocating the use of Dapagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor in heart failure with reduced ejection fraction (HFrEF) has raised some questions and concerns regarding the gaps in clinical trials and real world situation faced by the patients and providers [1]. At one hand, the medication proved to have a beneficial effect in the form of mortality reduction and reduced heart failure hospitalization in this large, phase III clinical trial. On the other hand, issues related to its cost, insurance approval, risk of polypharmacy (when used with other heart failure medications) arose. Moreover, where it fits in the spectrum of guideline directed medical therapy (GDMT) is also an important question that needs to be addressed in order to bridge the gap between the benefits seen in clinical trial and real-world situation.

References

1. McMurray JJ., et al. “On behalf of the DAPA-HF Trial Committees and Investigators. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction”. The New England Journal of Medicine 381 (2019): 1995-2008.
2. FDA Background Document. Endocrinologic and Metabolic Drugs Advisory Committee Meeting. (2018): 24-25. 
3. Zinman B., et al. “Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes”. The New England Journal of Medicine 373 (2015): 2117-2128. 
4. Neal B., et al. “Canagliflozin and cardiovascular and renal events in type 2 diabetes”. The New England Journal of Medicine 377 (2017): 644-657. 
5. Wiviott SD., et al. “Dapagliflozin and cardiovascular outcomes in type.
6. Kosiborod MN., et al. “Effects of Dapagliflozin on Symptoms, Function and Quality of Life in Patients with Heart Failure and Reduced Ejection Fraction: Results from the DAPA-HF Trial”. Circulation (2019).
7. Editorial. “Heart-Failure Therapy — New Drugs but Old Habits?” The New England Journal of Medicine 381 (2019): 2032-2042.
8. Jay Zimmermann Md. “Empagliflozin (Jardiance) for Type 2 Diabetes Mellitus”. American Family Physician 94.12 (2016): 1014-1015.
9. Greene SJ., et al. “Medical therapy for heart failure with reduced ejection fraction: the CHAMP-HF Registry”. Journal of the American College of Cardiology 72 (2018): 351-366.
10. Carolyn SP Lam., et al. “SGLT‐2 Inhibitors in Heart Failure: Current Management, Unmet Needs, and Therapeutic Prospects”. Journal of the American Heart Association 8 (2019): e013389.
11. Dapagliflozin Evaluation to Improve the LIVEs of Patients with Preserved Ejection Fraction Heart Failure. 

Citation

Citation: Salim Surani., et al. “Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors in Heart Failure; So Close Yet So Far". Acta Scientific Medical Sciences 4.2 (2020): 198-200.

Copyright

Copyright: © 2020 Salim Surani., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.