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CVD-REAL trial: lower risk of heart failure and death in patients treated with SGLT-2 inhibitors versus other glucose-lowering drugs


Reduction in cardiovascular death and hospitalization for heart failure ( HHF ) was reported with the sodium-glucose cotransporter-2 inhibitor ( SGLT-2i ) Empagliflozin ( Jardiance ) in patients with type 2 diabetes mellitus who have atherosclerotic cardiovascular disease.

Researchers have compared hospitalization for heart failure and death in patients newly initiated on any SGLT-2i versus other glucose-lowering drugs in 6 countries ( United States, Norway, Denmark, Sweden, Germany, and the United Kingdom ) to determine if these benefits are seen in real-world practice and across SGLT-2i class.

After propensity matching, there were 309 056 patients newly initiated on either SGLT-2i or other glucose-lowering drugs ( 154 528 patients in each treatment group ).
Canagliflozin ( Invokana ), Dapagliflozin ( Forxiga ), and Empagliflozin ( Jardiance ) accounted for 53%, 42%, and 5% of the total exposure time in the SGLT-2i class, respectively.
Baseline characteristics were balanced between the 2 groups.

There were 961 HHF cases during 190 164 person-years follow-up ( incidence rate, 0.51/100 person-years ).

Of 215 622 patients in the United States, Norway, Denmark, Sweden, and the United Kingdom, death occurred in 1334 ( incidence rate, 0.87/100 person-years ), and HHF or death in 1983 ( incidence rate, 1.38/100 person-years ).

Use of SGLT-2i, versus other glucose-lowering drugs, was associated with lower rates of HHF ( hazard ratio, HR=0.61; 95% confidence interval, 0.51-0.73; P less than 0.001 ); death ( HR=0.49; 95% confidence interval, 0.41-0.57; P less than 0.001 ); and HHF or death ( HR=0.54; 95% confidence interval, 0.48-0.60; P less than 0.001 ) with no significant heterogeneity by country.

In conclusion, the treatment with SGLT-2 inhibitors versus other glucose-lowering drugs was associated with a lower risk of hospitalization for heart failure and death, suggesting that the benefits seen with Empagliflozin in a randomized trial may be a class effect applicable to a broad population of patients with type 2 diabetes mellitus in real-world practice. ( Xagena )

Kosiborod M et al, Circulation 2017; 136: 249-259

XagenaMedicine_2017



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