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Zhang A, Kalil R, Marzec A, Coulter SA, Virani S, Patel KV, Segar MW. Cardiovascular Disease Management With Sodium-Glucose Cotransporter-2 Inhibitors in Patients With Type 2 Diabetes: A Cardiology Primer. Tex Heart Inst J 2024; 51:e238375. [PMID: 38590152 DOI: 10.14503/thij-23-8375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Patients with type 2 diabetes face an elevated risk of cardiovascular disease. This review centers on sodium-glucose cotransporter-2 (SGLT2) inhibitors, a class of drugs that, according to a growing body of evidence, may have major potential for managing cardiovascular disease in patients with type 2 diabetes. This review presents findings from multiple clinical trials suggesting that SGLT2 inhibitors can not only serve as preventive therapeutic agents but also play a role in the active management of heart failure. The discussion includes the mechanism of action of SGLT2 inhibitors, emphasizing that they enhance urinary glucose excretion, which could lead to improved glycemic control and contribute to metabolic shifts beneficial to cardiac function. Alongside these cardiometabolic effects, safety concerns and practical considerations for prescribing these agents are addressed, taking into account potential adverse effects such as genitourinary infections and diabetic ketoacidosis as well as the financial implications for patients. Despite these drawbacks, therapeutic indications for SGLT2 inhibitors continue to expand, including for kidney protection, although further research is necessary to fully understand the mechanisms driving the cardioprotective and kidney-protective effects of SGLT2 inhibitors. By synthesizing current knowledge, this review intends to inform and guide clinical decision-making, thereby enhancing cardiovascular disease outcomes in patients with type 2 diabetes.
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Affiliation(s)
- Allan Zhang
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ramsey Kalil
- Department of Cardiology, The Texas Heart Institute, Houston, Texas
| | - Alexander Marzec
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Salim Virani
- Department of Cardiology, The Texas Heart Institute, Houston, Texas
- Aga Khan University, Karachi, Pakistan
| | - Kershaw V Patel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Matthew W Segar
- Department of Cardiology, The Texas Heart Institute, Houston, Texas
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Forbes AK, Hinton W, Feher MD, Elson W, Ordóñez-Mena JM, Joy M, Fan X, Banerjee D, Cole NI, Munro N, Whyte M, Suckling RJ, Swift PA, de Lusignan S. A Comparison of Sodium-Glucose Co-Transporter 2 Inhibitor Kidney Outcome Trial Participants with a Real-World Chronic Kidney Disease Primary Care Population. Nephrol Dial Transplant 2024:gfae071. [PMID: 38520170 DOI: 10.1093/ndt/gfae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND/HYPOTHESIS Observational studies suggest sodium-glucose co-transporter-2 (SGLT2) inhibitor kidney outcome trials are not representative of the broader population of people with chronic kidney disease (CKD). However, there are limited data on the generalisability to those without co-existing type 2 diabetes (T2D), and the representativeness of the EMPA-KIDNEY trial has not been adequately explored. We hypothesised that SGLT2 inhibitor kidney outcome trials are more representative of people with co-existing T2D than those without, and that EMPA-KIDNEY is more representative than previous trials. METHODS A cross-sectional analysis of adults with CKD in English primary care was conducted using the Oxford-Royal College of General Practitioners Clinical Information Digital Hub. The proportions that met the eligibility criteria of SGLT2 inhibitor kidney outcome trials were determined, and their characteristics described. Logistic regression analyses were performed to identify factors associated with trial eligibility. RESULTS Of 6,670,829 adults, 516,491 (7.7%) with CKD were identified. In the real-world CKD population, 0.9%, 2.2%, and 8.0% met the CREDENCE, DAPA-CKD, and EMPA-KIDNEY eligibility criteria, respectively. All trials were more representative of people with co-existing T2D than those without T2D. Trial participants were 9-14 years younger than the real-world CKD population, and had more advanced CKD, including higher levels of albuminuria. A higher proportion of the CREDENCE (100%), DAPA-CKD (67.6%) and EMPA-KIDNEY (44.5%) trial participants had T2D compared to the real-world CKD population (32.8%). Renin-angiotensin system inhibitors were prescribed in almost all trial participants, compared to less than half of the real-world CKD population. Females were under-represented and less likely to be eligible for the trials. CONCLUSION SGLT2 inhibitor kidney outcome trials represent a sub-group of people with CKD at high risk of adverse kidney events. Out study highlights the importance of complementing trials with real-world studies, exploring the effectiveness of SGLT2 inhibitors in the broader population of people with CKD.
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Affiliation(s)
- Anna K Forbes
- Renal Services, Epsom & St. Helier University Hospitals NHS Trust, London, United Kingdom
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - William Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom
| | - Michael D Feher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - William Elson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Xuejuan Fan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Debasish Banerjee
- Renal & Transplantation Unit, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Nicholas I Cole
- Renal Services, Epsom & St. Helier University Hospitals NHS Trust, London, United Kingdom
| | - Neil Munro
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom
| | - Martin Whyte
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom
| | - Rebecca J Suckling
- Renal Services, Epsom & St. Helier University Hospitals NHS Trust, London, United Kingdom
| | - Pauline A Swift
- Renal Services, Epsom & St. Helier University Hospitals NHS Trust, London, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), London, UK
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Billing AM, Kim YC, Gullaksen S, Schrage B, Raabe J, Hutzfeldt A, Demir F, Kovalenko E, Lassé M, Dugourd A, Fallegger R, Klampe B, Jaegers J, Li Q, Kravtsova O, Crespo-Masip M, Palermo A, Fenton RA, Hoxha E, Blankenberg S, Kirchhof P, Huber TB, Laugesen E, Zeller T, Chrysopoulou M, Saez-Rodriguez J, Magnussen C, Eschenhagen T, Staruschenko A, Siuzdak G, Poulsen PL, Schwab C, Cuello F, Vallon V, Rinschen MM. Metabolic Communication by SGLT2 Inhibition. Circulation 2024; 149:860-884. [PMID: 38152989 PMCID: PMC10922673 DOI: 10.1161/circulationaha.123.065517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/22/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND SGLT2 (sodium-glucose cotransporter 2) inhibitors (SGLT2i) can protect the kidneys and heart, but the underlying mechanism remains poorly understood. METHODS To gain insights on primary effects of SGLT2i that are not confounded by pathophysiologic processes or are secondary to improvement by SGLT2i, we performed an in-depth proteomics, phosphoproteomics, and metabolomics analysis by integrating signatures from multiple metabolic organs and body fluids after 1 week of SGLT2i treatment of nondiabetic as well as diabetic mice with early and uncomplicated hyperglycemia. RESULTS Kidneys of nondiabetic mice reacted most strongly to SGLT2i in terms of proteomic reconfiguration, including evidence for less early proximal tubule glucotoxicity and a broad downregulation of the apical uptake transport machinery (including sodium, glucose, urate, purine bases, and amino acids), supported by mouse and human SGLT2 interactome studies. SGLT2i affected heart and liver signaling, but more reactive organs included the white adipose tissue, showing more lipolysis, and, particularly, the gut microbiome, with a lower relative abundance of bacteria taxa capable of fermenting phenylalanine and tryptophan to cardiovascular uremic toxins, resulting in lower plasma levels of these compounds (including p-cresol sulfate). SGLT2i was detectable in murine stool samples and its addition to human stool microbiota fermentation recapitulated some murine microbiome findings, suggesting direct inhibition of fermentation of aromatic amino acids and tryptophan. In mice lacking SGLT2 and in patients with decompensated heart failure or diabetes, the SGLT2i likewise reduced circulating p-cresol sulfate, and p-cresol impaired contractility and rhythm in human induced pluripotent stem cell-derived engineered heart tissue. CONCLUSIONS SGLT2i reduced microbiome formation of uremic toxins such as p-cresol sulfate and thereby their body exposure and need for renal detoxification, which, combined with direct kidney effects of SGLT2i, including less proximal tubule glucotoxicity and a broad downregulation of apical transporters (including sodium, amino acid, and urate uptake), provides a metabolic foundation for kidney and cardiovascular protection.
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Affiliation(s)
- Anja M. Billing
- Departments of Biomedicine (A.M.B., F.D., E.K., J.J., R.A.F., M.C., M.M.R.), Aarhus University, Denmark
| | - Young Chul Kim
- Departments of Medicine and Pharmacology, University of California San Diego, La Jolla (Y.C.K., M.C.-M., V.V.)
- VA San Diego Healthcare System, CA (Y.C.K., M.C.-M., V.V.)
| | - Søren Gullaksen
- Clinical Medicine (S.G., P.L.P.), Aarhus University, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark (S.G., E.L.)
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Germany (B.S., S.B., P.K., T.Z., C.M.)
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany (B.S., J.R., S.B., P.K., T.Z., C.M., T.E., F.C.)
| | - Janice Raabe
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany (B.S., J.R., S.B., P.K., T.Z., C.M., T.E., F.C.)
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.R., B.K., T.E., F.C.)
| | - Arvid Hutzfeldt
- III Department of Medicine and Hamburg Center for Kidney Health, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., M.L., E.H., T.B.H., M.M.R.)
| | - Fatih Demir
- Departments of Biomedicine (A.M.B., F.D., E.K., J.J., R.A.F., M.C., M.M.R.), Aarhus University, Denmark
| | - Elina Kovalenko
- Departments of Biomedicine (A.M.B., F.D., E.K., J.J., R.A.F., M.C., M.M.R.), Aarhus University, Denmark
| | - Moritz Lassé
- III Department of Medicine and Hamburg Center for Kidney Health, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., M.L., E.H., T.B.H., M.M.R.)
| | - Aurelien Dugourd
- Heidelberg University, Faculty of Medicine, and Heidelberg University Hospital, Institute for Computational Biomedicine, BioQuant, Heidelberg, Germany (A.D., R.F., J.S.-R.)
| | - Robin Fallegger
- Heidelberg University, Faculty of Medicine, and Heidelberg University Hospital, Institute for Computational Biomedicine, BioQuant, Heidelberg, Germany (A.D., R.F., J.S.-R.)
| | - Birgit Klampe
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.R., B.K., T.E., F.C.)
| | - Johannes Jaegers
- Departments of Biomedicine (A.M.B., F.D., E.K., J.J., R.A.F., M.C., M.M.R.), Aarhus University, Denmark
| | - Qing Li
- Engineering (Q.L., C.S.), Aarhus University, Denmark
| | - Olha Kravtsova
- Departments of Biomedicine (A.M.B., F.D., E.K., J.J., R.A.F., M.C., M.M.R.), Aarhus University, Denmark
| | - Maria Crespo-Masip
- Departments of Medicine and Pharmacology, University of California San Diego, La Jolla (Y.C.K., M.C.-M., V.V.)
- VA San Diego Healthcare System, CA (Y.C.K., M.C.-M., V.V.)
| | - Amelia Palermo
- Scripps Research, Center for Metabolomics, San Diego, CA (A.P., G.S., M.M.R.)
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles (A.P.)
| | - Robert A. Fenton
- Departments of Biomedicine (A.M.B., F.D., E.K., J.J., R.A.F., M.C., M.M.R.), Aarhus University, Denmark
| | - Elion Hoxha
- III Department of Medicine and Hamburg Center for Kidney Health, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., M.L., E.H., T.B.H., M.M.R.)
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Germany (B.S., S.B., P.K., T.Z., C.M.)
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany (B.S., J.R., S.B., P.K., T.Z., C.M., T.E., F.C.)
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Germany (B.S., S.B., P.K., T.Z., C.M.)
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany (B.S., J.R., S.B., P.K., T.Z., C.M., T.E., F.C.)
- Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (P.K.)
| | - Tobias B. Huber
- III Department of Medicine and Hamburg Center for Kidney Health, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., M.L., E.H., T.B.H., M.M.R.)
| | - Esben Laugesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark (S.G., E.L.)
- Diagnostic Centre, Silkeborg Regional Hospital, Denmark (E.L.)
| | - Tanja Zeller
- Department of Cardiology, University Heart and Vascular Center Hamburg, Germany (B.S., S.B., P.K., T.Z., C.M.)
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany (B.S., J.R., S.B., P.K., T.Z., C.M., T.E., F.C.)
| | - Maria Chrysopoulou
- Departments of Biomedicine (A.M.B., F.D., E.K., J.J., R.A.F., M.C., M.M.R.), Aarhus University, Denmark
| | - Julio Saez-Rodriguez
- Heidelberg University, Faculty of Medicine, and Heidelberg University Hospital, Institute for Computational Biomedicine, BioQuant, Heidelberg, Germany (A.D., R.F., J.S.-R.)
| | - Christina Magnussen
- Department of Cardiology, University Heart and Vascular Center Hamburg, Germany (B.S., S.B., P.K., T.Z., C.M.)
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany (B.S., J.R., S.B., P.K., T.Z., C.M., T.E., F.C.)
| | - Thomas Eschenhagen
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany (B.S., J.R., S.B., P.K., T.Z., C.M., T.E., F.C.)
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.R., B.K., T.E., F.C.)
| | - Alexander Staruschenko
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa (O.K., A.S.)
| | - Gary Siuzdak
- Scripps Research, Center for Metabolomics, San Diego, CA (A.P., G.S., M.M.R.)
| | - Per L. Poulsen
- Clinical Medicine (S.G., P.L.P.), Aarhus University, Denmark
- Steno Diabetes Center (P.L.P.), Aarhus University, Denmark
| | | | - Friederike Cuello
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany (B.S., J.R., S.B., P.K., T.Z., C.M., T.E., F.C.)
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.R., B.K., T.E., F.C.)
| | - Volker Vallon
- Departments of Medicine and Pharmacology, University of California San Diego, La Jolla (Y.C.K., M.C.-M., V.V.)
- VA San Diego Healthcare System, CA (Y.C.K., M.C.-M., V.V.)
| | - Markus M. Rinschen
- Departments of Biomedicine (A.M.B., F.D., E.K., J.J., R.A.F., M.C., M.M.R.), Aarhus University, Denmark
- Aarhus Institute of Advanced Studies (M.M.R.), Aarhus University, Denmark
- III Department of Medicine and Hamburg Center for Kidney Health, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (A.H., M.L., E.H., T.B.H., M.M.R.)
- Scripps Research, Center for Metabolomics, San Diego, CA (A.P., G.S., M.M.R.)
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McMurray JJV, Docherty KF, de Boer RA, Hammarstedt A, Kitzman DW, Kosiborod MN, Maria Langkilde A, Reicher B, Senni M, Shah SJ, Wilderäng U, Verma S, Solomon SD. Effect of Dapagliflozin Versus Placebo on Symptoms and 6-Minute Walk Distance in Patients With Heart Failure: The DETERMINE Randomized Clinical Trials. Circulation 2024; 149:825-838. [PMID: 38059368 DOI: 10.1161/circulationaha.123.065061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/02/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Sodium-glucose cotransporter 2 inhibitors reduce the risk of worsening heart failure (HF) and cardiovascular death in patients with HF irrespective of left ventricular ejection fraction. It is important to determine whether therapies for HF improve symptoms and functional capacity. METHODS The DETERMINE (Dapagliflozin Effect on Exercise Capacity Using a 6-Minute Walk Test in Patients With Heart Failure) double-blind, placebo-controlled, multicenter trials assessed the efficacy of the sodium-glucose cotransporter 2 inhibitor dapagliflozin on the Total Symptom Score (TSS) and Physical Limitation Scale (PLS) of the Kansas City Cardiomyopathy Questionnaire (KCCQ) and 6-minute walk distance (6MWD) in 313 patients with HF with reduced ejection fraction (DETERMINE-Reduced) and in 504 patients with HF with preserved ejection fraction (DETERMINE-Preserved) with New York Heart Association class II or III symptoms and elevated natriuretic peptide levels. The primary outcomes were changes in the KCCQ-TSS, KCCQ-PLS, and 6MWD after 16 weeks of treatment. RESULTS Among the 313 randomized patients with HF with reduced ejection fraction, the median placebo-corrected difference in KCCQ-TSS from baseline at 16 weeks was 4.2 (95% CI, 1.0, 8.2; P=0.022) in favor of dapagliflozin. The median placebo-corrected difference in KCCQ-PLS was 4.2 (95% CI, 0.0, 8.3; P=0.058). The median placebo-corrected difference in 6MWD from baseline at 16 weeks was 3.2 meters (95% CI, -6.5, 13.0; P=0.69). In the 504 patients with HF with preserved ejection fraction, the median placebo-corrected 16-week difference in KCCQ-TSS and KCCQ-PLS was 3.2 (95% CI, 0.4, 6.0; P=0.079) and 3.1 (-0.1, 5.4; P=0.23), respectively. The median 16-week difference in 6MWD was 1.6 meters (95% CI, -5.9, 9.0; P=0.67). In an exploratory post hoc analysis of both trials combined (DETERMINE-Pooled), the median placebo-corrected difference from baseline at 16 weeks was 3.7 (1.5, 5.9; P=0.005) for KCCQ-TSS, 4.0 (0.3, 4.9; P=0.036) for KCCQ-PLS, and 2.5 meters (-3.5, 8.4; P=0.50) for 6MWD. CONCLUSIONS Dapagliflozin improved the KCCQ-TSS in patients with HF with reduced ejection fraction but did not improve KCCQ-PLS or 6MWD. Dapagliflozin did not improve these outcomes in patients with HF with preserved ejection fraction. In a post hoc analysis including all patients across the full spectrum of ejection fraction, there was a beneficial effect of dapagliflozin on KCCQ-TSS and KCCQ-PLS but not 6MWD. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: NCT03877237 and NCT03877224.
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Affiliation(s)
- John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, UK (J.J.V.M., K.F.D.)
| | - Kieran F Docherty
- BHF Cardiovascular Research Centre, University of Glasgow, UK (J.J.V.M., K.F.D.)
| | - Rudolf A de Boer
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands (R.A.d.B.)
| | - Ann Hammarstedt
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research & Development, AstraZeneca, Gothenburg, Sweden (A.H., A.M.L., U.W.)
| | - Dalane W Kitzman
- Sections on Cardiovascular Medicine and Geriatrics/Gerontology, Wake Forest University School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City (M.N.K.)
| | - Anna Maria Langkilde
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research & Development, AstraZeneca, Gothenburg, Sweden (A.H., A.M.L., U.W.)
| | - Barry Reicher
- AstraZeneca BioPharmaceuticals Research & Development, Late-Stage Development, Cardiovascular, Renal and Metabolic, Gaithersburg, MD (B.R.)
| | - Michele Senni
- Cardiovascular Department, Papa Giovanni XXIII Hospital Bergamo, Italy (M.S.)
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Ulrica Wilderäng
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Research & Development, AstraZeneca, Gothenburg, Sweden (A.H., A.M.L., U.W.)
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Ontario, Canada (S.V.)
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (S.D.S.)
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Cleland JGF. Nature and Magnitude of the Benefits of Dapagliflozin and Empagliflozin for Heart Failure. Circulation 2024; 149:839-842. [PMID: 38466791 DOI: 10.1161/circulationaha.123.068089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Affiliation(s)
- John G F Cleland
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom
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Sohn TS, Han KA, Kim Y, Lee BW, Chon S, Jeong IK, Hong EG, Son JW, Na J, Cho JM, In Cho S, Huh W, Yoon KH. A 52-week efficacy and safety study of enavogliflozin versus dapagliflozin as an add-on to metformin in patients with type 2 diabetes mellitus: ENHANCE-M extension study. Diabetes Obes Metab 2024. [PMID: 38456558 DOI: 10.1111/dom.15537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 03/09/2024]
Abstract
AIM To evaluate the long-term safety and efficacy of enavogliflozin 0.3 mg/day added to metformin in patients with type 2 diabetes mellitus. MATERIALS AND METHODS After 24 weeks of a randomized, double-blind treatment period with enavogliflozin 0.3 mg/day (n = 101) or dapagliflozin 10 mg/day (n = 99) added to metformin, all patients received enavogliflozin 0.3 mg/day plus metformin for an additional 28 weeks during the open-label extension period. RESULTS Eighty-two patients continued enavogliflozin (maintenance group), and 77 were switched from dapagliflozin to enavogliflozin (switch group). All adverse drug reactions (ADR) were mild in severity. In the maintenance group, ADRs (cystitis and vaginal infection) were reported in two patients (2.44%) during 52 weeks. In the switch group, ADR (hypoglycaemia) was reported in one patient (1.30%) during a 28-week open-label extension period. At week 52, glycated haemoglobin and fasting plasma glucose were significantly lower than at the baseline, by 0.85% and 29.08 mg/dl, respectively, in the maintenance group (p < .0001 for both), and by 0.81% and 32.77 mg/dl, respectively, in the switch group (p < .0001 for both). At week 52, 68.92% of patients from the maintenance group and 64.29% from the switch group achieved glycated haemoglobin <7%. A significant increase in the urine glucose-creatinine ratio was observed at week 52, by 58.81 g/g and 63.77 g/g in the maintenance and switch groups, respectively (p < .0001). CONCLUSIONS Enavogliflozin added to metformin was tolerated well for up to 52 weeks and provided continual glycaemic control in type 2 diabetes mellitus, along with a significant increase in the urine glucose-creatinine ratio.
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Affiliation(s)
- Tae Seo Sohn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu St Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, South Korea
| | - Kyung-Ah Han
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Yonghyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Bundang Jesaeng Hospital, Seongnam, South Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Suk Chon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, South Korea
| | - In-Kyung Jeong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Eun-Gyoung Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Jang Won Son
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Bucheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, South Korea
| | - JaeJin Na
- Clinical Development Center, Daewoong Pharmaceutical Co. Ltd, Seoul, South Korea
| | - Jae Min Cho
- Clinical Development Center, Daewoong Pharmaceutical Co. Ltd, Seoul, South Korea
| | - Seong In Cho
- Clinical Development Center, Daewoong Pharmaceutical Co. Ltd, Seoul, South Korea
| | - Wan Huh
- Clinical Development Center, Daewoong Pharmaceutical Co. Ltd, Seoul, South Korea
| | - Kun-Ho Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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7
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Schumacher C, Chorpash A, Bolch C, Eagan K, Nimer S, Van Dril E. Identification of risk factors associated with acute kidney injury in patients taking sodium-glucose cotransporter-2 inhibitors. Pharmacotherapy 2024; 44:249-257. [PMID: 38131129 DOI: 10.1002/phar.2902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/11/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
STUDY OBJECTIVE Studies have demonstrated sodium-glucose cotransporter-2 (SGLT2) inhibitors are kidney protective; however, their ability to cause hemodynamic changes may predispose patients to acute kidney injury (AKI). An FDA warning recommends evaluating for factors that predispose patients to AKI before initiating a SGLT2 inhibitor. The primary objective of this study is to identify risk factors that may predispose persons with diabetes to AKI when initiating SGLT2 inhibitor therapy. DESIGN Multicenter retrospective cohort chart review. DATA SOURCE Study patients were identified through an electronic medical record generated report if they had type 2 diabetes and were prescribed a SGLT2 inhibitor from January 2013 to September 2019. PATIENTS Patients were included if they were receiving care at Advocate Medical Group and were confirmed to have taken one of the four SGLT2 inhibitors available at the time of study approval, canagliflozin, dapagliflozin, empagliflozin, or ertugliflozin, for at least 7 days. Patients were excluded if they did not have a basic metabolic panel or comprehensive metabolic panel recorded 1 year prior to or 6 months after SGLT2 inhibitor therapy initiation. RESULTS Data extraction from the electronic medical record identified 6425 patients receiving a SGLT2 inhibitor, of which 1962 met inclusion criteria and were included for analysis. Thirty-five (1.8%) patients experienced an AKI after SGLT2 inhibitor therapy initiation. There was no statistically significant difference between groups based on background medication use (p = 0.325). At baseline, patients experiencing an AKI after SGLT2 inhibitor initiation were more likely to be older in age (p = 0.010), have a higher serum potassium (p < 0.001), blood glucose (p = 0.018), SCr (p = 0.009) and UACR (p < 0.001), and a lower eGFR (p = 0.028) compared to those who did not experience AKI. CONCLUSIONS The transient eGFR decline with SGLT2 inhibitor initiation should be expected and is generally not an indication to discontinue therapy. Future initiatives should be directed at increasing knowledge of monitoring recommendations for these agents.
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Affiliation(s)
- Christie Schumacher
- Department of Pharmacy Practice, Midwestern University College of Pharmacy, Downers Grove Campus, Downers Grove, Illinois, USA
- Pharmacy, Chronic Disease Management, Advocate Health, Chicago, Illinois, USA
| | - Amanda Chorpash
- Pharmacy, Chronic Disease Management, Advocate Health, Chicago, Illinois, USA
| | - Charlotte Bolch
- Office of Research and Sponsored Programs, Midwestern University, Glendale, Arizona, USA
| | - Kellye Eagan
- Pharmacy, Chronic Disease Management, Advocate Health, Chicago, Illinois, USA
| | - Sara Nimer
- Pharmacy, Chronic Disease Management, Advocate Health, Chicago, Illinois, USA
| | - Elizabeth Van Dril
- Department of Pharmacy Practice, University of Illinois Chicago College of Pharmacy, Chicago, Illinois, USA
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8
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Hullon D, Taherifard E, Al-Saraireh TH. The effect of the four pharmacological pillars of heart failure on haemoglobin level. Ann Med Surg (Lond) 2024; 86:1575-1583. [PMID: 38463117 PMCID: PMC10923357 DOI: 10.1097/ms9.0000000000001773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/21/2024] [Indexed: 03/12/2024] Open
Abstract
Anaemia, a condition characterized by low levels of haemoglobin, is frequently observed in patients with heart failure (HF). Guideline-directed medical therapy improves HF outcomes by using medications like beta blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers, along with mineralocorticoid receptor antagonists and sodium-glucose cotransporter 2 inhibitors. In this study, we aimed to review the pathophysiology of anaemia in patients with HF and present the current evidence regarding the relationship between the main recommended medications for these patients and haemoglobin levels. The authors conducted a comprehensive search in the medical literature for relevant original clinical articles in which the four pharmacological pillars of HF were given to the patients; we, then, assessed whether the association of use of these medications and haemoglobin level or development of anaemia was provided. These common medications have been shown in the literature that may exacerbate or ameliorate anaemia. Besides, it has been shown that even in the case that they result in the development of anaemia, their use is associated with positive effects that outweigh this potential harm. The literature also suggests that among patients receiving medications with negative effects on the level of haemoglobin, there was no difference in the rate of mortality between anaemic and non-anaemic patients when both were on treatment for anaemia; this point highlights the importance of the detection and treatment of anaemia in these patients. Further research is needed to explore these relationships and identify additional strategies to mitigate the risk of anaemia in this population.
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Affiliation(s)
| | - Erfan Taherifard
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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9
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Hopper RA, McMahan DM, Jarvis KA, Weideman RA. Risk of Urinary Infections in Veterans on Empagliflozin With Concurrent Catheter Use. J Pharm Pract 2024:8971900241229107. [PMID: 38241151 DOI: 10.1177/08971900241229107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
There has been concern over whether to use sodium-glucose-cotransporter-2 (SGLT-2) inhibitors in patients that use catheters due to the concern for increased urinary tract infections (UTIs). The concern is that patients who use catheters are already at an increased risk for UTIs and that SGLT-2-inhibitors may promote bacterial growth due their mechanism of action, ie. increasing glycosuria. The objective of this study was to evaluate whether using empagliflozin, a SGLT-2-inhibitor, in patients who also use catheters, increases their risks for UTIs. A retrospective chart review of electronic health records at a single-center was completed of all Veterans who received an empagliflozin prescription and were also using catheters between October 1, 2015 and September 30, 2022. Veterans were included if they were using catheters for at least 2 months prior to starting empagliflozin and were on both therapies for at least 2 months concurrently. The primary outcome for this study is the number of UTIs occurring prior to and after beginning empagliflozin treatment. Additional secondary outcomes included change in A1c, change in body mass index (BMI), UTI-hospitalizations, and fungal infections. Of the 91 patients with concurrent empagliflozin and catheter-use, only 25 Veterans were included. There was an occurrence of .09 UTIs/month pre-empagliflozin compared to .07 post-empagliflozin (P = .61). There was an observed trend in Veterans with Type 2 Diabetes having an increased rate of UTIs. There was no statistically significant difference found in UTI rates when comparing catheters alone to concurrent catheter and empagliflozin-use.
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Affiliation(s)
- Rachel A Hopper
- Department of Pharmacy, Veterans Affairs North Texas Health Care System, Dallas, TX, USA
| | - Danni M McMahan
- Department of Pharmacy, Veterans Affairs North Texas Health Care System, Dallas, TX, USA
| | - Kathryn A Jarvis
- Department of Pharmacy, Veterans Affairs North Texas Health Care System, Dallas, TX, USA
| | - Rick A Weideman
- Department of Pharmacy, Veterans Affairs North Texas Health Care System, Dallas, TX, USA
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10
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Mårup FH, Thomsen MB, Birn H. Additive effects of dapagliflozin and finerenone on albuminuria in non-diabetic CKD: an open-label randomized clinical trial. Clin Kidney J 2024; 17:sfad249. [PMID: 38186886 PMCID: PMC10768792 DOI: 10.1093/ckj/sfad249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Indexed: 01/09/2024] Open
Abstract
Background Dapagliflozin and finerenone reduce albuminuria and slow CKD progression, but additive effects remain unstudied. We compared their individual and combined efficacy and safety in patients with non-diabetic CKD. Methods In an open-label, randomized clinical trial, we included patients aged 18-80 on maximal tolerated ACE inhibitor or angiotensin receptor blocker with eGFR 25-45 mL/min/1,73 m2 and albuminuria 150-2000 mg/g. Participants received either finerenone 20 mg/day or dapagliflozin 10 mg/day for four weeks, followed by combination therapy for four weeks. Data were collected at baseline, 4 and 8 weeks. Results Twenty patients (10 per group) with a mean mGFR of 34 mL/min/1,73 m2 and a mean urine albumin creatinine ratio (UACR) of 469 mg/g were included. Finerenone alone or in addition to dapagliflozin resulted in -24% (95% CI, -36% to -11%) and -34% (95% CI, -47% to -18%) change in UACR, respectively. Dapagliflozin alone or in addition to finerenone resulted in -8% (95% CI, -22 to 9%) and -10% (95% CI, -28% to 12%) change in UACR, respectively. Overall, UACR change after 8 weeks was -36% (95% CI, -46% to -24%). After 8 weeks, systolic blood pressure and mGFR were reduced by 10 mmHg (95% CI, 6-13 mmHg) and 7 mL/min/1,73 m2 (95% CI, 5-8 mL/min/1,73 m2). Adverse effects were minimal. Conclusions The combination of finerenone and dapagliflozin was safe and significantly reduced albuminuria. The effect of combination therapy was at least equal to the calculated, combined effect of each of the drugs, suggesting an additive effect on albuminuria. Larger studies assessing long-term effects and safety are warranted.
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Affiliation(s)
- Frederik Husum Mårup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | | | - Henrik Birn
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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11
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Tavares CDAM, de Azevedo LCP, Rea-Neto Á, Campos NS, Amendola CP, Bergo RR, Kozesinski-Nakatani AC, David-João PG, Westphal GA, Guimarães Júnior MRR, Lobo SMA, Tavares MS, Dracoulakis MDA, de Souza GM, de Almeida GMB, Gebara OCE, Tomba PO, Albuquerque CSN, Silva MCR, Pereira AJ, Damiani LP, Corrêa TD, Serpa-Neto A, Berwanger O, Zampieri FG. Dapagliflozin in patients with critical illness: rationale and design of the DEFENDER study. Crit Care Sci 2023; 35:256-265. [PMID: 38133155 PMCID: PMC10734800 DOI: 10.5935/2965-2774.20230129-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/09/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Critical illness is a major ongoing health care burden worldwide and is associated with high mortality rates. Sodium-glucose cotransporter-2 inhibitors have consistently shown benefits in cardiovascular and renal outcomes. The effects of sodium-glucose cotransporter-2 inhibitors in acute illness have not been properly investigated. METHODS DEFENDER is an investigator-initiated, multicenter, randomized, open-label trial designed to evaluate the efficacy and safety of dapagliflozin in 500 adult participants with acute organ dysfunction who are hospitalized in the intensive care unit. Eligible participants will be randomized 1:1 to receive dapagliflozin 10mg plus standard of care for up to 14 days or standard of care alone. The primary outcome is a hierarchical composite of hospital mortality, initiation of kidney replacement therapy, and intensive care unit length of stay, up to 28 days. Safety will be strictly monitored throughout the study. CONCLUSION DEFENDER is the first study designed to investigate the use of a sodium-glucose cotransporter-2 inhibitor in general intensive care unit patients with acute organ dysfunction. It will provide relevant information on the use of drugs of this promising class in critically ill patients. CLINICALTRIALS.GOV REGISTRY NCT05558098.
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Affiliation(s)
| | | | - Álvaro Rea-Neto
- Centro de Estudos e de Pesquisas em Terapia Intensiva - Curitiba
(PR), Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ary Serpa-Neto
- Hospital Israelita Albert Einstein - São Paulo (SP),
Brazil
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12
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Meregildo-Rodriguez ED, Asmat-Rubio MG, Vásquez-Tirado GA. SGLT-2 inhibitors and prevention of contrast-induced nephropathy in patients with diabetes undergoing coronary angiography and percutaneous coronary interventions: systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1307715. [PMID: 38179307 PMCID: PMC10765513 DOI: 10.3389/fendo.2023.1307715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction SGLT2 inhibitors (SGLT2Is) have demonstrated cardioprotective and nephroprotective effects in patients with and without diabetes. Recent studies suggest that SGLT2Is may reduce the risk of contrast-induced nephropathy (CIN) in patients with diabetes undergoing coronary arteriography (CAG) or percutaneous coronary interventions (PCI). However, the evidence is still inconclusive. We aimed to systematically review the evidence regarding the potential nephroprotective role of SGLT2Is in preventing CIN in this population. Methods We searched for studies in six databases published up to September 30, 2023, following a PECO/PICO strategy. Initially, we meta-analyzed five studies, but due to several reasons, mainly methodological concerns, we excluded one RCT. In our final meta-analysis, we included four observational studies. Results This meta-analysis comprised 2,572 patients with diabetes undergoing CAG or PCI, 512 patients treated with SGLT2Is, and 289 events of CIN. This is the first meta-analysis demonstrating that SGLT2Is may reduce the risk of developing CIN by up to 63% (RR 0.37; 95% CI 0.24-0.58) in patients with diabetes undergoing CAG or PCI, compared to not using SGLT2Is. Statistical heterogeneity was not significant (I2 = 0%, p = 0.91). We assessed the certainty of the evidence of this systematic review and meta-analysis, according to the GRADE criteria, as moderate. Conclusion SGLT2Is significantly reduce the risk of CIN by up to 63% in patients with diabetes undergoing CAG or PCI. Clinical trials are needed; several are already underway, which could confirm our findings and investigate other unresolved issues, such as the optimal dose, type, and duration of SGLT2 inhibitor therapy to prevent CIN. Systematic Review PROSPERO, identifier CRD42023412892.
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13
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Dogan NB, Yasar HY, Kilicaslan B. Cardioprotective Effects of Sodium-Glucose Cotransporter 2 Inhibitors and Their Possible Association With Normalization of the Circadian Index of Heart Rhythm. Tex Heart Inst J 2023; 50:e238196. [PMID: 38083821 PMCID: PMC10751477 DOI: 10.14503/thij-23-8196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Updated recommendations for the treatment of heart failure with reduced ejection fraction (HFrEF) include sodium-glucose cotransporter 2 (SGLT2) inhibitors and other long-established HFrEF therapies. These drugs' mechanisms of action have yet to be fully clarified. OBJECTIVE This study evaluated the effects of SGLT2 inhibitors on the modulation of autonomic function at 1 month beyond conventional HF therapy. METHODS This single-center, observational, prospective study was conducted from January 2020 to December 2022. Patients with type 2 diabetes who had ischemic HFrEF and met the study criteria were considered for SGLT2 inhibitor treatment with empagliflozin or dapagliflozin. Changes in the circadian index were used as the primary outcome to assess the early effects of SGLT2 inhibitors on autonomic function. Changes in functional effort capacity and laboratory findings were also evaluated. Participants' circadian index was measured by a 24-hour rhythm Holter monitoring recorder (BTL-08 Holter H100). A symptom-limited treadmill test assessed patients' effort capacities. Tests were repeated after 1 month of therapy. RESULTS The mean (SD) age of the 151 participants was 56.95 (7.29) years; their mean (SD) left ventricular EF was 35.69% (7.10%), and 95 participants were men (62.9%). From baseline to 1 month, mean (SD) daytime heart rate (80.63 [9.17] vs 77.67 [8.04] beats per minute; P = .004) and nighttime heart rate (76.83 [11.34] vs 73.81 [10.25] beats per minute; P = .03) decreased significantly. Variation in the circadian indexes (mean [SD], 1.04 [0.02] vs 1.10 [0.04]; P < .001) was statistically significant, favoring increased modulation of autonomic function. The increases in exercise duration (mean [SD], 8.88 [3.69] minutes and median [IQR], 8.81 [5.76-12.13] minutes vs 9.72 [3.14] and 9.59 [7.24-12.22] minutes; P = .04) and exercise capacity (mean [SD], 203.38 [65.18] m and median [IQR], 119.22 [149.43-259.15] m vs 335.61 [51.39] and 325.79 [293.59-376.91] m; P < .001] were also significant. CONCLUSION The use of SGLT2 inhibitors during early treatment can favorably affect both autonomic dysfunction and functional effort capacity of patients with type 2 diabetes with ischemic HFrEF.
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Affiliation(s)
- Nazile Bilgin Dogan
- Department of Cardiology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Hamiyet Yilmaz Yasar
- Department of Endocrinology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
| | - Baris Kilicaslan
- Department of Cardiology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
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14
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Lewis GD, Gosch K, Cohen LP, Nassif ME, Windsor SL, Borlaug BA, Kitzman DW, Shah SJ, Khumri T, Umpierrez G, Lamba S, Sharma K, Khan SS, Kosiborod MN, Sauer AJ. Effect of Dapagliflozin on 6-Minute Walk Distance in Heart Failure With Preserved Ejection Fraction: PRESERVED-HF. Circ Heart Fail 2023; 16:e010633. [PMID: 37869881 PMCID: PMC10655911 DOI: 10.1161/circheartfailure.123.010633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/08/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Heart failure with preserved ejection fraction is associated with significant functional limitations, yet treatments for improving exercise performance have been elusive. We sought to explore the association between prespecified patient characteristics and changes in 6-minute walk distance that constitute a clinically significant response to dapagliflozin. METHODS We performed a responder analysis to understand patient characteristics associated with clinically meaningful improvement in 6-minute walk test (6MWT) distance ≥15 m among patients randomized to 12 weeks of dapagliflozin versus placebo in the double-blind PRESERVED-HF trial (Effects of Dapagliflozin on Biomarkers, Symptoms and Functional Status in Patients With Preserved Ejection Fraction Heart Failure). RESULTS A total of 289 randomized patients had 6MWT distance completed at baseline and 12 weeks. Patients randomized to dapagliflozin improved walking distance by ≥15 m more frequently than those on placebo (n=64, 44% versus n=48, 34%). After adjusting for baseline covariates, patients randomized to dapagliflozin were more likely to experience a clinically meaningful improvement in 6MWT distance compared with those that received placebo (adjusted odds ratio, 1.66 [95% CI, 1.00-2.75]; P=0.05). Dapagliflozin-treated patients were also less likely to have a ≥15 m reduction in 6MWT distance compared with placebo-treated patients (adjusted odds ratio, 0.56 [95% CI, 0.33-0.94]; P=0.03). These results were consistent across all prespecified subgroups (all P values for interaction were not significant). CONCLUSIONS Compared with those on placebo, patients with heart failure with preserved ejection fraction randomized to dapagliflozin were more likely to experience a clinically meaningful improvement and less likely to experience a deterioration in physical function over 12 weeks as measured by 6MWT distance. Beneficial response to dapagliflozin was consistent across prespecified subgroups. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03030235.
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Affiliation(s)
- Gregory D. Lewis
- Cardiology Division, Massachusetts General Hospital, Boston (G.D.L., L.P.C.)
| | - Kensey Gosch
- Saint Luke’s Mid America Heart Institute, Kansas City, MO (K.G., M.E.N., S.L.W., T.K., M.N.K., A.J.S.)
- University of Missouri-Kansas City School of Medicine (K.G., M.E.N., T.K., M.N.K., A.J.S.)
| | - Laura P. Cohen
- Cardiology Division, Massachusetts General Hospital, Boston (G.D.L., L.P.C.)
| | - Michael E. Nassif
- Saint Luke’s Mid America Heart Institute, Kansas City, MO (K.G., M.E.N., S.L.W., T.K., M.N.K., A.J.S.)
- University of Missouri-Kansas City School of Medicine (K.G., M.E.N., T.K., M.N.K., A.J.S.)
| | - Sheryl L. Windsor
- Saint Luke’s Mid America Heart Institute, Kansas City, MO (K.G., M.E.N., S.L.W., T.K., M.N.K., A.J.S.)
| | - Barry A. Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - Dalane W. Kitzman
- Department of Internal Medicine, Sections on Cardiovascular Medicine and Geriatrics, Wake Forest University School of Medicine, Winston-Salem, NC (D.W.K.)
| | - Sanjiv J. Shah
- Department of Medicine and Bluhm Cardiovascular Institute, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., S.S.K.)
| | - Taiyeb Khumri
- Saint Luke’s Mid America Heart Institute, Kansas City, MO (K.G., M.E.N., S.L.W., T.K., M.N.K., A.J.S.)
- University of Missouri-Kansas City School of Medicine (K.G., M.E.N., T.K., M.N.K., A.J.S.)
| | | | - Sumant Lamba
- First Coast Cardiovascular Institute, Jacksonville, FL (S.L.)
| | - Kavita Sharma
- Johns Hopkins University School of Medicine, Baltimore, MD (K.S.)
| | - Sadiya S. Khan
- Department of Medicine and Bluhm Cardiovascular Institute, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S., S.S.K.)
| | - Mikhail N. Kosiborod
- Cardiology Division, Massachusetts General Hospital, Boston (G.D.L., L.P.C.)
- University of Missouri-Kansas City School of Medicine (K.G., M.E.N., T.K., M.N.K., A.J.S.)
| | - Andrew J. Sauer
- Saint Luke’s Mid America Heart Institute, Kansas City, MO (K.G., M.E.N., S.L.W., T.K., M.N.K., A.J.S.)
- University of Missouri-Kansas City School of Medicine (K.G., M.E.N., T.K., M.N.K., A.J.S.)
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15
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Zannad F, Macari S. Drug treatment with empagliflozin was beneficial in people with heart failure with preserved ejection fraction: plain language summary of the EMPEROR-Preserved study. Future Cardiol 2023; 19:671-677. [PMID: 37942723 DOI: 10.2217/fca-2023-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
WHAT IS THIS SUMMARY ABOUT? This summary describes a study of a new pill for treating chronic heart failure called empagliflozin (brand name Jardiance®). The study is called EMPEROR-Preserved and was published in the New England Journal of Medicine. Chronic heart failure is a condition where the heart does not pump blood around the body properly. Heart failure causes symptoms such as shortness of breath, tiredness and build-up of too much water in the body (fluid retention). These symptoms often need hospital treatment and increase the risk of early death. WHAT WAS THE EMPEROR-PRESERVED STUDY? The EMPEROR-Preserved study looked at how empagliflozin works in people living with a type of heart failure called heart failure with preserved ejection fraction. In this type of heart failure, the lower left chamber (ventricle) of the heart is too stiff to fill with enough blood during each heartbeat. WHAT HAPPENED DURING THE STUDY? Almost 6000 people living with preserved ejection fraction heart failure were asked to take either a pill containing empagliflozin or a placebo, an identical pill lacking empagliflozin, daily. The choice of pill for each participant was randomly assigned. The study was double-blinded, meaning that neither the participants nor their doctors knew which pill the participants were taking. WHAT WERE THE RESULTS? After an average of 26 months of treatment, empagliflozin reduced the risk of participants needing hospital treatment for complications of heart failure by about 30%. Side effects were generally similar in participants who took empagliflozin and in those who took the placebo, except for genital infections like thrush, which happened in more people who took empagliflozin (2.2%) than in those who took the placebo (0.7%). WHAT DO THE RESULTS MEAN? A previous study called EMPEROR-Reduced found that empagliflozin had similar benefits in participants with heart failure with reduced ejection fraction. Therefore, the overall evidence shows that empagliflozin can help people with heart failure whether it is caused by reduced ejection fraction or preserved ejection fraction. Clinical Trial Registration: NCT03057951 (EMPEROR-Preserved study) (ClinicalTrials.gov).
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Affiliation(s)
- Faiez Zannad
- Université de Lorraine, Inserm INI-CRCT, CHRU, Nancy, France
| | - Steven Macari
- Patient author
- The Heart Failure Policy Network
- Global Heart Hub, Galway, Ireland
- INI-CRCT Expert Patient Committee Member
- President of AVEC Heart Failure Patient Group
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16
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Li CX, Liu TT, Zhang Q, Xie Q, Geng XH, Man CX, Li JY, Mao XY, Qiao Y, Liu H. Safety of sodium-glucose transporter 2 (SGLT-2) inhibitors in patients with type 2 diabetes: a meta-analysis of cohort studies. Front Pharmacol 2023; 14:1275060. [PMID: 37905204 PMCID: PMC10613530 DOI: 10.3389/fphar.2023.1275060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/21/2023] [Indexed: 11/02/2023] Open
Abstract
Aims: This study aimed to investigate the association between the use of sodium-glucose transporter 2 inhibitors (SGLT-2i) and the risk of diabetic ketoacidosis (DKA), lower limb amputation (LLA), urinary tract infections (UTI), genital tract infections (GTI), bone fracture, and hypoglycemia in cohort studies. Methods: A systematic search was conducted in the PubMed and Embase databases to identify cohort studies comparing the safety of SGLT-2i versus other glucose-lowering drugs (oGLD) in patients with type 2 diabetes mellitus (T2DM). The quality of the studies was assessed using the Newcastle-Ottawa Scale. Primary endpoints were DKA and LLA, while secondary endpoints included UTI, GTI, bone fracture, and hypoglycemia. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated. Results: A total of 9,911,454 patients from 40 cohort studies were included in the analysis. SGLT-2i use was associated with a higher risk of DKA (HR: 1.21, 95% CI: 1.07-1.38, p = 0.003) and GTI (HR: 2.72, 95% CI: 2.48-2.98, p < 0.01). However, it was not associated with an increased risk of LLA (HR: 1.06, 95% CI: 0.92-1.23, p = 0.42), UTI (HR: 0.99, 95% CI: 0.89-1.10, p = 0.83), or bone fracture (HR: 0.99, 95% CI: 0.94-1.04, p = 0.66). Furthermore, SGLT-2i was associated with a reduced risk of hypoglycemia. Furthermore, compared to dipeptidyl peptidase 4 inhibitors, SGLT-2i as a class and individually was associated with an increased risk of DKA. Canagliflozin specifically increased the risk of LLA (HR: 1.19, 95% CI: 1.04-1.36, p = 0.01). The subgroup analysis suggested that SGLT-2i increased the risk of LLA among patients with a history of cardiovascular disease. Conclusion: SGLT-2i versus oGLD was associated with a similar occurrence of LLA, UTI, and bone fracture. However, SGLT-2i was associated with a higher risk of DKA and GTI than oGLD. These findings provide valuable information on the safety profile of SGLT-2i in patients with T2DM and can help inform clinical decision-making.
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Affiliation(s)
- Chun Xing Li
- Department of Pharmacy, Aerospace Center Hospital, Beijing, China
| | - Tian Tian Liu
- Department of Pharmacy, Aerospace Center Hospital, Beijing, China
| | - Qian Zhang
- College of Pharmacy, Hebei Medical University, Shijiazhuang, China
| | - Qing Xie
- Department of Pharmacy, Aerospace Center Hospital, Beijing, China
| | - Xu Hua Geng
- Aerospace School of Clinical Medicine, Peking University, Beijing, China
| | - Chun Xia Man
- Department of Pharmacy, Aerospace Center Hospital, Beijing, China
| | - Jia Yi Li
- Department of Pharmacy, Aerospace Center Hospital, Beijing, China
| | - Xin Ying Mao
- Department of Pharmacy, Aerospace Center Hospital, Beijing, China
| | - Yue Qiao
- Department of Pharmacy, Aerospace Center Hospital, Beijing, China
| | - Hua Liu
- Department of Pharmacy, Aerospace Center Hospital, Beijing, China
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Zannad F, Macari S. Drug treatment with empagliflozin lowered risk for hospitalization in people with heart failure with reduced ejection fraction: plain language summary of the EMPEROR-Reduced study. Future Cardiol 2023; 19:625-630. [PMID: 37942680 DOI: 10.2217/fca-2023-0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
WHAT IS THIS SUMMARY ABOUT? This is a summary of the article describing the EMPEROR-Reduced study of empagliflozin, which was published in the New England Journal of Medicine. Empagliflozin (brand name Jardiance®) is a new drug therapy for the treatment of chronic heart failure. Chronic heart failure is a long-term condition where the heart cannot pump enough blood around the body, leading to symptoms such as shortness of breath, fatigue and build-up of too much water in the body (fluid retention). It also increases the risk for premature death. WHAT WAS THE EMPEROR-REDUCED STUDY? The EMPEROR-Reduced study looked at the effects of empagliflozin, a medication taken once daily, in people with reduced ejection fraction. This is a type of heart failure where insufficient blood is pushed out of the heart muscle as it contracts. The study was conducted because more evidence is needed on the effects of empagliflozin and similar drugs in people with heart failure, including those with reduced ejection fraction. The main aim of the EMPEROR-Reduced study was to see if empagliflozin reduces the risk of being taken to hospital for complications of heart failure or dying from heart disease. WHAT HAPPENED DURING THE STUDY? Over 3700 people with heart failure and reduced ejection fraction were randomly given either empagliflozin or placebo (an identical pill lacking medication) daily for about 16 months. This was a double-blind study, which means that neither the participants nor the researchers knew which treatment participants were receiving. WHAT WERE THE RESULTS? After an average of 16 months of continuous treatment, fewer patients taking empagliflozin (13.2%) needed to be hospitalized for complications of heart failure than those taking placebo (18.3%). Also, fewer patients taking empagliflozin (1.6%) developed serious kidney problems than those taking placebo (3.1%). Side effects were generally similar in participants who received empagliflozin and those who received placebo, except for genital tract infections, which affected more participants who received empagliflozin (1.7%) than placebo (0.6%). WHAT DO THE RESULTS MEAN? This study suggests that people with chronic heart failure with reduced ejection fraction may benefit from treatment with empagliflozin, mainly by needing to go to hospital less often because of complications of heart failure. Clinical Trial Registration: NCT03057977 (EMPEROR-Reduced study) (ClinicalTrials.gov).
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Affiliation(s)
- Faiez Zannad
- Université de Lorraine, Inserm INI-CRCT, CHRU, Nancy, France
| | - Steven Macari
- Patient author
- The Heart Failure Policy Network
- Global Heart Hub, Galway, Ireland
- INI-CRCT Expert Patient Committee Member
- President of AVEC Heart Failure Patient Group
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18
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Packer M, Butler J, Zeller C, Pocock SJ, Brueckmann M, Ferreira JP, Filippatos G, Usman MS, Zannad F, Anker SD. Blinded Withdrawal of Long-Term Randomized Treatment With Empagliflozin or Placebo in Patients With Heart Failure. Circulation 2023; 148:1011-1022. [PMID: 37621153 PMCID: PMC10516173 DOI: 10.1161/circulationaha.123.065748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND It is not known whether the benefits of sodium-glucose cotransporter 2 inhibitors in heart failure persist after years of therapy. METHODS In the EMPEROR-Reduced (Empagliflozin Outcome Trials in Chronic Heart Failure With Reduced Ejection Fraction) and EMPEROR-Preserved (Empagliflozin Outcome Trials in Chronic Heart Failure With Preserved Ejection Fraction) trials, patients with heart failure were randomly assigned (double-blind) to placebo or empagliflozin 10 mg/day for a median of 16 and 26 months, respectively. At the end of the trials, 6799 patients (placebo 3381, empagliflozin 3418) were prospectively withdrawn from treatment in a blinded manner, and, of these, 3981 patients (placebo 2020, empagliflozin 1961) underwent prespecified in-person assessments after ≈30 days off treatment. RESULTS From 90 days from the start of closeout to the end of double-blind treatment, the annualized risk of cardiovascular death or hospitalization for heart failure was lower in empagliflozin-treated patients than in placebo-treated patients (10.7 [95% CI, 9.0-12.6] versus 13.5 [95% CI, 11.5-15.6] events per 100 patient-years, respectively; hazard ratio 0.76 [95% CI, 0.60-0.96]). When the study drugs were withdrawn for ≈30 days, the annualized risk of cardiovascular death or hospitalization for heart failure increased in patients withdrawn from empagliflozin but not in those withdrawn from placebo (17.0 [95% CI, 12.6-22.1] versus 14.1 [95% CI, 10.1-18.8] events per 100 patient-years for empagliflozin and placebo, respectively). The hazard ratio for the change in risk in the patients withdrawn from empagliflozin was 1.75 (95% CI, 1.20-2.54), P=0.0034, whereas the change in the risk in patients withdrawn from placebo was not significant (hazard ratio 1.12 [95% CI, 0.76-1.66]); time period-by-treatment interaction, P=0.068. After withdrawal, the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score declined by 1.6±0.4 in patients withdrawn from empagliflozin versus placebo (P<0.0001). Furthermore, withdrawal of empagliflozin was accompanied by increases in fasting glucose, body weight, systolic blood pressure, estimated glomerular filtration rate, N-terminal pro-hormone B-type natriuretic peptide, uric acid, and serum bicarbonate and decreases in hemoglobin and hematocrit (all P<0.01). These physiological and laboratory changes were the inverse of the effects of the drug seen at the start of the trials during the initiation of treatment (≈1-3 years earlier) in the same cohort of patients. CONCLUSIONS These observations demonstrate a persistent effect of empagliflozin in patients with heart failure even after years of treatment, which dissipated rapidly after withdrawal of the drug. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifiers: NCT03057977 and NCT03057951.
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Affiliation(s)
- Milton Packer
- Baylor University Medical Center, Dallas, TX (M.P.)
- Imperial College, London, United Kingdom (M.P.)
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX (J.B.)
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MS (J.B.)
| | - Cordula Zeller
- Boehringer Ingelheim Pharma GmbH and Co KG, Biberach, Germany (C.Z.)
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, United Kingdom (S.J.P.)
| | - Martina Brueckmann
- Boehringer Ingelheim International GmbH, Ingelheim, Germany (M.B.)
- First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Germany (M.B.)
| | - João Pedro Ferreira
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Portugal (J.P.F.)
- Centre d'Investigations Cliniques Plurithématique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Nancy, France (J.P.F., F.Z.)
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens School of Medicine, Athens University Hospital Attikon, Athens, Greece (G.F.)
| | - Muhammad Shariq Usman
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (M.S.U.)
| | - Faiez Zannad
- Centre d'Investigations Cliniques Plurithématique 14-33, and Inserm U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Nancy, France (J.P.F., F.Z.)
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin (S.D.A.)
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19
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Plattner C, Pirklbauer M, Mayer G. Advice and challenges in the pharmacotherapeutic management of diabetic kidney disease in adults. Expert Opin Pharmacother 2023; 24:1747-1752. [PMID: 37599563 DOI: 10.1080/14656566.2023.2244420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/01/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Clemens Plattner
- Department of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Markus Pirklbauer
- Department of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
| | - Gert Mayer
- Department of Internal Medicine IV - Nephrology and Hypertension, Medical University Innsbruck, Innsbruck, Austria
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20
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Li CX, Liu LY, Zhang CX, Geng XH, Gu SM, Wang YQ, Liu H, Xie Q, Liang S. Comparative safety of different sodium-glucose transporter 2 inhibitors in patients with type 2 diabetes: a systematic review and network meta-analysis of randomized controlled trials. Front Endocrinol (Lausanne) 2023; 14:1238399. [PMID: 37701900 PMCID: PMC10494439 DOI: 10.3389/fendo.2023.1238399] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 07/26/2023] [Indexed: 09/14/2023] Open
Abstract
Backgrounds The safety of different sodium-glucose transporter 2 (SGLT-2) inhibitors remains uncertain due to the lack of head-to-head comparisons. Methods This network meta-analysis (NMA) was performed to compare the safety of nine SGLT-2 inhibitors in patients with type 2 diabetes (T2DM). PubMed, Embase, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov were searched for studies published in English before August 30, 2022. Published and unpublished randomized controlled trials (RCTs) comparing the safety of individual SGLT-2 inhibitors in patients with T2DM were included. A Bayesian NMA with random effects model was applied. Subgroup and sensitivity analyses were performed. The quality of the evidence was evaluated using the Confidence in Network Meta-Analysis framework. Results Nine SGLT-2 inhibitors were evaluated in 113 RCTs (12 registries) involving 105,293 adult patients. Reproductive tract infections (RTIs) were reported in 1,967 (4.51%) and 276 (1.01%) patients in the SGLT-2 inhibitor and placebo groups, respectively. Furthermore, pollakiuria was reported in 233 (2.66%) and 45 (0.84%) patients, respectively. Compared to placebo, a significantly higher risk of RTIs was observed with canagliflozin, ertugliflozin, empagliflozin, remogliflozin, dapagliflozin, and sotagliflozin, but not with luseogliflozin and ipragliflozin, regardless of gender. An increased risk of pollakiuria was observed with dapagliflozin [odds ratio (OR) 10.40, 95% confidence interval (CI) 1.60-157.94) and empagliflozin (OR 5.81, 95%CI 1.79-32.97). Remogliflozin (OR 6.45, 95%CI 2.18-27.79) and dapagliflozin (OR 1.33, 95%CI 1.10-1.62) were associated with an increased risk of urinary tract infections (UTIs). Instead, the included SGLT-2 inhibitors had a protective effect against acute kidney injury (AKI). No significant differences were found for hypovolemia, renal impairment or failure, fracture, diabetic ketoacidosis (DKA), amputation, and severe hypoglycemia between the SGLT-2 inhibitor and the placebo groups. Conclusion In patients with T2DM, dapagliflozin was associated with an increased risk of RTIs, pollakiuria, and UTIs. Empagliflozin increased the risk of RTIs and pollakiuria. Remogliflozin increased the risk of UTIs. None of the SGLT-2 inhibitors showed a significant difference from the placebo for hypovolemia, renal impairment or failure, fracture, DKA, amputation, and severe hypoglycemia. The findings guide the selection of SGLT-2 inhibitors for patients with T2DM based on the patient's profiles to maximize safety. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier CRD42022334644.
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Affiliation(s)
- Chun Xing Li
- Department of Pharmacy, Aerospace Center Hospital, Beijing, China
| | - Li Yan Liu
- Department of Pharmacy, Aerospace Center Hospital, Beijing, China
| | - Chen Xiao Zhang
- Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xu Hua Geng
- Department of Gastroenterology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Si Meng Gu
- Department of Pharmacy, Aerospace Center Hospital, Beijing, China
| | - Yu Qiao Wang
- Department of Pharmacy, Aerospace Center Hospital, Beijing, China
| | - Hua Liu
- Department of Pharmacy, Aerospace Center Hospital, Beijing, China
| | - Qing Xie
- Department of Pharmacy, Aerospace Center Hospital, Beijing, China
| | - Shuo Liang
- Department of Pharmacy, Aerospace Center Hospital, Beijing, China
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21
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Hayes KN, Berry SD, Munshi MN, Zullo AR. Adoption of sodium-glucose cotransporter-2 inhibitors among prescribers caring for nursing home residents. J Am Geriatr Soc 2023; 71:2585-2592. [PMID: 37078149 PMCID: PMC10528819 DOI: 10.1111/jgs.18360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/17/2023] [Accepted: 03/09/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Sodium-glucose cotransporter-2 inhibitor (SGLT2I) use has increased among community-dwelling populations, but little is known about how clinicians have prescribed them for US nursing home (NH) residents. We described the adoption of SGLT2Is by prescribers caring for long-stay NH residents by clinician specialty and over time, compared with sulfonylureas, an older diabetes medication class. METHODS We conducted a retrospective cohort study of prescribers of SGLT2Is and sulfonylureas for all long-stay US NH residents aged 65 years or older (2017-2019). Using 100% of Medicare Part D claims linked to prescriber characteristics data, we identified all dispensings of SGLT2Is and sulfonylureas for long-stay NH residents and their associated prescribers. We described the distribution of prescriber specialties for each drug class over time as well as the number of NH residents prescribed SGLT2s versus sulfonylureas. We estimated the proportions of prescribers who prescribed both drug classes versus only sulfonylureas or only SGLT2Is. RESULTS We identified 36,427 unique prescribers (SGLT2I: N = 5811; sulfonylureas: N = 35,443) for 117,667 NH residents between 2017 and 2019. For both classes, family medicine and internal medicine physicians accounted for most prescriptions (75%-81%). Most clinicians (87%) prescribed only sulfonylureas, 2% prescribed SGLT2Is only, and 11% prescribed both. Geriatricians were least likely to prescribe only SGLT2Is. We observed an increase in the number of residents with SGLT2I use from n = 2344 in 2017 to n = 5748 in 2019. CONCLUSIONS Among NH residents, most clinicians have not incorporated SGLT2Is into their prescribing for diabetes, but the extent of use is increasing. Family medicine and internal medicine physicians prescribed the majority of diabetes medications for NH residents, and geriatricians were the least likely to prescribe only SGLT2Is. Future research should explore provider concerns regarding SGLT2I prescribing, particularly adverse events.
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Affiliation(s)
- Kaleen N. Hayes
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Graduate Department of Pharmaceutical Sciences, University of Toronto Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada
| | - Sarah D. Berry
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Medha N. Munshi
- Harvard Medical School, Boston, Massachusetts, USA
- Joslin Diabetes Center, 1 Joslin Place, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Andrew R. Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
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22
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Kaku K, Nakayama Y, Yabuuchi J, Naito Y, Kanasaki K. Safety and effectiveness of empagliflozin in clinical practice as monotherapy or with other glucose-lowering drugs in Japanese patients with type 2 diabetes: subgroup analysis of a 3-year post-marketing surveillance study. Expert Opin Drug Saf 2023; 22:819-832. [PMID: 37194266 DOI: 10.1080/14740338.2023.2213477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors such as empagliflozin are increasingly prescribed as initial glucose-lowering drugs for type 2 diabetes (T2D), based on their cardiorenal benefits. However, information regarding the safety and the effectiveness of monotherapy with SGLT2 inhibitors in routine clinical practice is limited. RESEARCH DESIGN AND METHODS We analyzed data from a prospective, 3-year, post-marketing surveillance study of empagliflozin in Japan. We evaluated adverse drug reactions (ADRs) (the primary endpoint) and glycemic effectiveness with or without other glucose-lowering drugs. RESULTS 7931 T2D patients were treated with empagliflozin. At baseline, mean age was 58.7 years, 63.0% were male, and 1835 (23.14%) were not receiving other glucose-lowering drugs. ADRs occurred in 141 (7.68%) and 875 (14.62%) patients initiating empagliflozin as monotherapy or combination therapy, respectively. The most frequent ADRs of special interest with empagliflozin as monotherapy or combination therapy were urinary tract infections (0.82% and 1.14% of patients, respectively) and excessive/frequent urination (0.65%, 1.50%). At last observation, glycated hemoglobin level was reduced by a mean of 0.78% with empagliflozin monotherapy (from baseline mean of 7.55%) and 0.74% with combination therapy (baseline 8.16%). CONCLUSIONS Empagliflozin is well tolerated and effective in clinical practice in Japan when initiated as monotherapy or combination therapy.
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Affiliation(s)
- Kohei Kaku
- Department of Medicine, Kawasaki Medical School, Okayama, Japan
| | - Yayoi Nakayama
- Medicine Division, Nippon Boehringer Ingelheim Co. Ltd, Tokyo, Japan
| | - Junko Yabuuchi
- Medicines Development Unit Japan and Medical Affairs, Eli Lilly Japan K.K, Kobe, Japan
| | - Yusuke Naito
- Medicine Division, Nippon Boehringer Ingelheim Co. Ltd, Tokyo, Japan
| | - Keizo Kanasaki
- Department of Internal Medicine 1, Faculty of Medicine, Shimane University, Izumo, Japan
- Division of Anticipatory Molecular Food Science and Technology, Medical Research Institute, Kanazawa Medical University, Kahoku-gun, Japan
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23
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Stottlemyer BA, McDermott MC, Minogue MR, Gray MP, Boyce RD, Kane-Gill SL. Assessing adverse drug reaction reports for antidiabetic medications approved by the food and drug administration between 2012 and 2017: a pharmacovigilance study. Ther Adv Drug Saf 2023; 14:20420986231181334. [PMID: 37332887 PMCID: PMC10272667 DOI: 10.1177/20420986231181334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Objective Between 2012 and 2017, the U.S. Food and Drug Administration (FDA) approved 10 antidiabetic indicated therapies. Due to the limited literature on voluntarily reported safety outcomes for recently approved antidiabetic drugs, this study investigated adverse drug reactions (ADRs) reported in the FDA Adverse Event Reporting System (FAERS). Research Design and Methods A disproportionality analysis of spontaneously reported ADRs was conducted. FAERS reports from January 1, 2012 to March 31, 2022 were compiled, allowing a 5-year buffer following drug approval in 2017. Reporting odds ratios were calculated for the top 10 ADRs, comparing new diabetic agents to the other approved drugs in their therapeutic class. Results 127,525 reports were identified for newly approved antidiabetic medications listed as the primary suspect (PS). For sodium-glucose co-transporter-2 (SGLT-2) inhibitors, the odds of blood glucose increased, nausea, and dizziness being reported was greater for empagliflozin. Dapagliflozin was associated with greater reports of weight decreased. Canagliflozin was found to have a disproportionally higher number of reports for diabetic ketoacidosis, toe amputation, acute kidney injury, fungal infections, and osteomyelitis. Assessing glucagon-like peptide-1 (GLP-1) receptor agonists, dulaglutide and semaglutide were associated with greater reports of gastrointestinal adverse drug reactions. Exenatide was disproportionally associated with injection site reactions and pancreatic carcinoma reports. Conclusion Pharmacovigilance studies utilizing a large publicly available dataset allow an essential opportunity to evaluate the safety profile of antidiabetic drugs utilized in clinical practice. Additional research is needed to evaluate these reported safety concerns for recently approved antidiabetic medications to determine causality.
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Affiliation(s)
| | | | | | - Matthew P. Gray
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard D. Boyce
- School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
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Liew A, Lydia A, Matawaran BJ, Susantitaphong P, Tran HTB, Lim LL. Practical considerations for the use of SGLT-2 inhibitors in the Asia-Pacific countries-An expert consensus statement. Nephrology (Carlton) 2023. [PMID: 37153973 DOI: 10.1111/nep.14167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
Recent clinical studies have demonstrated the effectiveness of SGLT-2 inhibitors in reducing the risks of cardiovascular and renal events in both patients with and without type 2 diabetes mellitus. Consequently, many international guidelines have begun advocating for the use of SGLT-2 inhibitors for the purpose of organ protection rather than as simply a glucose-lowering agent. However, despite the consistent clinical benefits and available strong guideline recommendations, the utilization of SGLT-2 inhibitors have been unexpectedly low in many countries, a trend which is much more noticeable in low resource settings. Unfamiliarity with the recent focus in their organ protective role and clinical indications; concerns with potential adverse effects of SGLT-2 inhibitors, including acute kidney injury, genitourinary infections, euglycemic ketoacidosis; and their safety profile in elderly populations have been identified as deterring factors to their more widespread use. This review serves as a practical guide to clinicians managing patients who could benefit from SGLT-2 inhibitors treatment and instill greater confidence in the initiation of these drugs, with the aim of optimizing their utilization rates in high-risk populations.
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Affiliation(s)
- Adrian Liew
- The Kidney & Transplant Practice, Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Aida Lydia
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Bien J Matawaran
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Huong Thi Bich Tran
- Renal Division, Department of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Lee Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Asia Diabetes Foundation, Hong Kong, SAR, China
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Chan YH, Chao TF, Chen SW, Kao YW, Huang CY, Chu PH. The Association of Background Medications on Initial eGFR Change and Kidney Outcomes in Diabetic Patients Receiving SGLT2 Inhibitor. Clin J Am Soc Nephrol 2023; 18:01277230-990000000-00114. [PMID: 36999982 PMCID: PMC10356138 DOI: 10.2215/cjn.0000000000000159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/17/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND To determine whether background medications modify the effects of sodium-glucose cotransporter-2 inhibitor (SGLT2i) on the eGFR and kidney outcomes among patients with type 2 diabetes. METHODS We used medical data from a multicenter health care facility in Taiwan and included 10,071 patients who received SGLT2i treatment from June 1, 2016, to December 31, 2018. Direct comparisons for use versus no use of specific background drugs were conducted after adjusting for baseline characteristics through propensity score matching. Patients were followed up until the occurrence of composite kidney outcomes (two-fold increase in the serum creatinine level or the development of end-stage kidney disease), mortality, or the end of the study period. RESULTS Patients exhibited an initial mean (SEM) decline of -2.72 (0.10) ml/min per 1.73 m 2 in eGFR dip from baseline to a mean treatment duration of 8.1±3.1 weeks after SGLT2i initiation. The eGFR trajectory stabilized 24 weeks after SGLT2i treatment with a mean (SEM) slope of -1.36 (0.25) ml/min per 1.73 m 2 per year. Compared with no drug use, the use of background renin-angiotensin inhibitor ( n =2073), thiazide diuretics ( n =1764), loop diuretics ( n =708), fenofibrate ( n =1043), xanthine oxidase inhibitor ( n =264), and insulin ( n =1656) was associated with a larger initial decrease in eGFR, while background metformin treatment ( n =827) was associated with a smaller initial decrease in eGFR after SGLT2i treatment. The only drugs associated with the long-term composite kidney outcome during SGLT2i treatment were renin-angiotensin inhibitor (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.40 to 0.95) and loop diuretics (HR, 1.88; 95% CI, 1.19 to 2.96). CONCLUSIONS Several background medications were associated with the initial eGFR dip after SGLT2i initiation. Most drugs were not associated with long-term composite kidney outcomes among patients treated with SGLT2i, except for renin-angiotensin system inhibitor associated with favorable outcomes and loop diuretics associated with worse composite kidney outcomes.
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Affiliation(s)
- Yi-Hsin Chan
- The Cardiovascular Department, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang-Gung University, Taoyuan City, Taiwan
- Microscopy Core Laboratory, Linkou Chang Gung Memorial Hospital,Taoyuan City, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
- Cardiovascular Research Center, Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Linkou Medical Center, Department of Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
- Center for Big Data Analytics and Statistics, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Yi-Wei Kao
- Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei City, Taiwan
- Department of Applied Statistics and Information Science, Ming Chuan University, Taoyuan City, Taiwan
| | - Chien-Ying Huang
- The Cardiovascular Department, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Pao-Hsien Chu
- The Cardiovascular Department, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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Wang X, Vaduganathan M, Claggett BL, Hegde SM, Pabon M, Kulac IJ, Vardeny O, O’Meara E, Zieroth S, Katova T, McGrath MM, Pouleur AC, Jhund PS, Desai AS, Inzucchi SE, Kosiborod MN, de Boer RA, Kober L, Sabatine MS, Martinez FA, Ponikowski P, Shah SJ, Hernandez AF, Langkilde AM, McMurray JJ, Solomon SD, Lam CS. Sex Differences in Characteristics, Outcomes, and Treatment Response With Dapagliflozin Across the Range of Ejection Fraction in Patients With Heart Failure: Insights From DAPA-HF and DELIVER. Circulation 2023; 147:624-634. [PMID: 36342789 PMCID: PMC9974767 DOI: 10.1161/circulationaha.122.062832] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sodium-glucose cotransporter-2 inhibitors have emerged as a key pharmacotherapy in heart failure (HF) with both reduced and preserved ejection fraction. The benefit of other HF therapies may be modified by sex, but whether sex modifies the treatment effect and safety profile of sodium-glucose cotransporter-2 inhibitors remains unclear. Our analyses aim to assess the effect of sex on the efficacy and safety of dapagliflozin. METHODS In a prespecified patient-level pooled analysis of DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure) and DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure), clinical outcomes were compared by sex (including the composite of cardiovascular death or worsening HF events, cardiovascular death, all-cause death, total events [first and recurrent HF hospitalization and cardiovascular death], and Kansas City Cardiomyopathy Questionnaire scores) across the spectrum of left ventricular ejection fraction. RESULTS Of a total of 11 007 randomized patients, 3856 (35%) were women. Women with HF were older and had higher body mass index but were less likely to have a history of diabetes and myocardial infarction or stroke and more likely to have hypertension and atrial fibrillation compared with men. At baseline, women had higher ejection fraction but worse Kansas City Cardiomyopathy Questionnaire scores than men did. After adjustment for baseline differences, women were less likely than men to experience cardiovascular death (adjusted hazard ratio, 0.69 [95% CI, 0.60-0.79]), all-cause death (adjusted hazard ratio, 0.69 [95% CI, 0.62-0.78]), HF hospitalizations (adjusted hazard ratio, 0.82 [95% CI, 0.72-0.94]), and total events (adjusted rate ratio, 0.77 [95% CI, 0.71-0.84]). Dapagliflozin reduced the primary end point in both men and women similarly (Pinteraction=0.77) with no sex-related differences in secondary outcomes (all Pinteraction>0.35) or safety events. The benefit of dapagliflozin was observed across the entire ejection fraction spectrum and was not modified by sex (Pinteraction>0.40). There were no sex-related differences in serious adverse events, adverse events, or drug discontinuation attributable to adverse events. CONCLUSIONS In DAPA-HF and DELIVER, the response to dapagliflozin was similar between men and women. Sex did not modify the treatment effect of dapagliflozin across the range of ejection fraction.
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Affiliation(s)
- Xiaowen Wang
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian L. Claggett
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sheila M. Hegde
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maria Pabon
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ian J. Kulac
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Orly Vardeny
- The Minneapolis Veterans Affairs Center for Care Delivery and Outcomes Research, University of Minnesota, Minneapolis, Minnesota
| | - Eileen O’Meara
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montréal, Canada
| | - Shelley Zieroth
- Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tzvetana Katova
- Department of Noninvasive Cardiology, National Cardiology Hospital, Sofia, Bulgaria
| | - Martina M. McGrath
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anne-Catherine Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc; Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Pardeep S. Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Akshay S. Desai
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Mikhail N. Kosiborod
- Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
| | - Rudolf A. de Boer
- Erasmus Medical Center, Department of Cardiology, Rotterdam, the Netherlands
| | - Lars Kober
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Marc S. Sabatine
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts,TIMI Study Group, Boston, Massachusetts
| | | | | | - Sanjiv J. Shah
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Adrian F. Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Anna Maria Langkilde
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | | | - Scott D. Solomon
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts,Co-corresponding authors
| | - Carolyn S.P. Lam
- National Heart Centre Singapore & Duke-National University of Singapore, Singapore, Singapore,Co-corresponding authors
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Isidto R, Danguilan R, Naidas O, Vilanueva R, Arakama MH, Paraiso LM. Emerging Role of Sodium-Glucose Co-Transporter 2 Inhibitors for the Treatment of Chronic Kidney Disease. Int J Nephrol Renovasc Dis 2023; 16:43-57. [PMID: 36852177 PMCID: PMC9960786 DOI: 10.2147/ijnrd.s387262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/24/2022] [Indexed: 02/25/2023] Open
Abstract
Chronic kidney disease is one of the leading causes of morbidity and mortality in the Philippines. It is associated with a growing health burden as many patients progress to end-stage renal disease. Until recently, therapeutic options for the management of chronic kidney disease were limited. Sodium-glucose co-transporter 2 inhibitors offer an alternative therapeutic approach for patients with chronic kidney disease. Several trials have shown renal benefits with sodium-glucose co-transporter 2 inhibitors in patients with cardiovascular disease with and without type 2 diabetes and across a range of estimated glomerular filtration rate levels. In the Philippines, the sodium-glucose co-transporter 2 inhibitors dapagliflozin and canagliflozin are approved for the prevention of new and worsening nephropathy in type 2 diabetes. With emerging treatment options, an urgent need exists for guidance on the management of chronic kidney disease within the Philippines. In this review, we focus on the putative renal-protective mechanisms of sodium-glucose co-transporter 2 inhibitors, including effects on tubuloglomerular feedback, albuminuria, endothelial function, erythropoiesis, uric acid levels, renal oxygen demand, and hypoxia. Furthermore, we discuss the findings of recent large clinical trials using sodium-glucose co-transporter 2 inhibitors in patients with chronic kidney disease and diabetic kidney disease, summarize safety aspects, and outline the practical management of patients with chronic kidney disease in the Philippines.
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Affiliation(s)
- Rey Isidto
- HealthLink Medical, Surgical, Dental Clinics and Diagnostic Center, Iloilo City, Iloilo, Philippines,Correspondence: Rey Isidto, HealthLink Medical, Surgical, Dental Clinics and Diagnostic Center, Iloilo City, Iloilo, Philippines, Tel +63 9178406232, Fax +63 33 3303863, Email
| | - Romina Danguilan
- Department of Adult Nephrology, National Kidney and Transplant Institute, Quezon City, Manila, Philippines
| | - Oscar Naidas
- Department of Adult Nephrology, St. Luke’s Medical Center, Quezon City, Manila, Philippines
| | - Russell Vilanueva
- Department of Adult Nephrology, National Kidney and Transplant Institute, Quezon City, Manila, Philippines
| | - Mel-Hatra Arakama
- Department of Adult Nephrology, National Kidney and Transplant Institute, Quezon City, Manila, Philippines
| | - Layla Marie Paraiso
- Department of Adult Nephrology, National Kidney and Transplant Institute, Quezon City, Manila, Philippines
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28
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Connelly KA, Mazer CD, Puar P, Teoh H, Wang CH, Mason T, Akhavein F, Chang CW, Liu MH, Yang NI, Chen WS, Juan YH, Opingari E, Salyani Y, Barbour W, Pasricha A, Ahmed S, Kosmopoulos A, Verma R, Moroney M, Bakbak E, Krishnaraj A, Bhatt DL, Butler J, Kosiborod MN, Lam CSP, Hess DA, Rizzi Coelho-Filho O, Lafreniere-Roula M, Thorpe KE, Quan A, Leiter LA, Yan AT, Verma S. Empagliflozin and Left Ventricular Remodeling in People Without Diabetes: Primary Results of the EMPA-HEART 2 CardioLink-7 Randomized Clinical Trial. Circulation 2023; 147:284-295. [PMID: 36335517 DOI: 10.1161/circulationaha.122.062769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sodium-glucose cotransporter 2 inhibitors have been demonstrated to promote reverse cardiac remodeling in people with diabetes or heart failure. Although it has been theorized that sodium-glucose cotransporter 2 inhibitors might afford similar benefits in people without diabetes or prevalent heart failure, this has not been evaluated. We sought to determine whether sodium-glucose cotransporter 2 inhibition with empagliflozin leads to a decrease in left ventricular (LV) mass in people without type 2 diabetes or significant heart failure. METHODS Between April 2021 and January 2022, 169 individuals, 40 to 80 years of age, without diabetes but with risk factors for adverse cardiac remodeling were randomly assigned to empagliflozin (10 mg/d; n=85) or placebo (n=84) for 6 months. The primary outcome was the 6-month change in LV mass indexed (LVMi) to baseline body surface area as measured by cardiac magnetic resonance imaging. Other measures included 6-month changes in LV end-diastolic and LV end-systolic volumes indexed to baseline body surface area and LV ejection fraction. RESULTS Among the 169 participants (141 men [83%]; mean age, 59.3±10.5 years), baseline LVMi was 63.2±17.9 g/m2 and 63.8±14.0 g/m2 for the empagliflozin- and placebo-assigned groups, respectively. The difference (95% CI) in LVMi at 6 months in the empagliflozin group versus placebo group adjusted for baseline LVMi was -0.30 g/m2 (-2.1 to 1.5 g/m2; P=0.74). Median baseline (interquartile range) NT-proBNP (N-terminal-pro B-type natriuretic peptide) was 51 pg/mL (20-105 pg/mL) and 55 pg/mL (21-132 pg/mL) for the empagliflozin- and placebo-assigned groups, respectively. The 6-month treatment effect of empagliflozin versus placebo (95% CI) on blood pressure and NT-proBNP (adjusted for baseline values) were -1.3 mm Hg (-5.2 to 2.6 mm Hg; P=0.52), 0.69 mm Hg (-1.9 to 3.3 mm Hg; P=0.60), and -6.1 pg/mL (-37.0 to 24.8 pg/mL; P=0.70) for systolic blood pressure, diastolic blood pressure, and NT-proBNP, respectively. No clinically meaningful between-group differences in LV volumes (diastolic and systolic indexed to baseline body surface area) or ejection fraction were observed. No difference in adverse events was noted between the groups. CONCLUSIONS Among people with neither diabetes nor significant heart failure but with risk factors for adverse cardiac remodeling, sodium-glucose cotransporter 2 inhibition with empagliflozin did not result in a meaningful reduction in LVMi after 6 months. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04461041.
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Affiliation(s)
- Kim A Connelly
- Division of Cardiology (K.A.C., F.A., A.T.Y.), St. Michael's Hospital of Unity Health Toronto, ON, Canada.,Department of Medicine (K.A.C., L.A.L., A.T.Y.), University of Toronto, ON, Canada.,Department of Physiology (K.A.C., C.D.M.), University of Toronto, ON, Canada
| | - C David Mazer
- Department of Anesthesia (C.D.M.), St. Michael's Hospital of Unity Health Toronto, ON, Canada.,Department of Physiology (K.A.C., C.D.M.), University of Toronto, ON, Canada.,Department of Anesthesiology and Pain Medicine (C.D.M.), University of Toronto, ON, Canada
| | - Pankaj Puar
- Division of Cardiac Surgery (P.P., H.T., T.M., E.O., Y.S., W.B., A.P., S.A., A. Kosmopoulos, R.V., M.M., E.B., A. Krishnaraj, A.Q., S.V.), St. Michael's Hospital of Unity Health Toronto, ON, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada (P.P., S.A.)
| | - Hwee Teoh
- Division of Cardiac Surgery (P.P., H.T., T.M., E.O., Y.S., W.B., A.P., S.A., A. Kosmopoulos, R.V., M.M., E.B., A. Krishnaraj, A.Q., S.V.), St. Michael's Hospital of Unity Health Toronto, ON, Canada.,Division of Endocrinology and Metabolism (H.T., L.A.L.), St. Michael's Hospital of Unity Health Toronto, ON, Canada
| | - Chao-Hung Wang
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine (C.-H.W., C.-W.C., M.-H.L., N.-I.Y., W.-S.C.), Keelung Chang Gung Memorial Hospital, Taiwan.,School of Medicine (C.-H.W., C.-W.C., N.-I.Y., Y.-H.J.), Chang Gung University, Taoyuan, Taiwan
| | - Tamique Mason
- Division of Cardiac Surgery (P.P., H.T., T.M., E.O., Y.S., W.B., A.P., S.A., A. Kosmopoulos, R.V., M.M., E.B., A. Krishnaraj, A.Q., S.V.), St. Michael's Hospital of Unity Health Toronto, ON, Canada
| | - Farhad Akhavein
- Division of Cardiology (K.A.C., F.A., A.T.Y.), St. Michael's Hospital of Unity Health Toronto, ON, Canada
| | - Ching-Wen Chang
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine (C.-H.W., C.-W.C., M.-H.L., N.-I.Y., W.-S.C.), Keelung Chang Gung Memorial Hospital, Taiwan.,Department of Diagnostic Radiology (C.-W.C.), Keelung Chang Gung Memorial Hospital, Taiwan.,School of Medicine (C.-H.W., C.-W.C., N.-I.Y., Y.-H.J.), Chang Gung University, Taoyuan, Taiwan
| | - Min-Hui Liu
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine (C.-H.W., C.-W.C., M.-H.L., N.-I.Y., W.-S.C.), Keelung Chang Gung Memorial Hospital, Taiwan.,Department of Nursing, Ching Kuo Institute of Management and Health, Keelung, Taiwan (M.-H.L.)
| | - Ning-I Yang
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine (C.-H.W., C.-W.C., M.-H.L., N.-I.Y., W.-S.C.), Keelung Chang Gung Memorial Hospital, Taiwan.,School of Medicine (C.-H.W., C.-W.C., N.-I.Y., Y.-H.J.), Chang Gung University, Taoyuan, Taiwan
| | - Wei-Siang Chen
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine (C.-H.W., C.-W.C., M.-H.L., N.-I.Y., W.-S.C.), Keelung Chang Gung Memorial Hospital, Taiwan.,Intensive Care Unit, Division of Cardiology, Department of Internal Medicine (W.-S.C.), Keelung Chang Gung Memorial Hospital, Taiwan
| | - Yu-Hsiang Juan
- School of Medicine (C.-H.W., C.-W.C., N.-I.Y., Y.-H.J.), Chang Gung University, Taoyuan, Taiwan.,Institute for Radiological Research (Y.-H.J.), Chang Gung University, Taoyuan, Taiwan.,Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (Y.-H.J.)
| | - Erika Opingari
- Division of Cardiac Surgery (P.P., H.T., T.M., E.O., Y.S., W.B., A.P., S.A., A. Kosmopoulos, R.V., M.M., E.B., A. Krishnaraj, A.Q., S.V.), St. Michael's Hospital of Unity Health Toronto, ON, Canada.,Temerty Faculty of Medicine (E.O., A. Kosmopoulos), University of Toronto, ON, Canada
| | - Yaseen Salyani
- Division of Cardiac Surgery (P.P., H.T., T.M., E.O., Y.S., W.B., A.P., S.A., A. Kosmopoulos, R.V., M.M., E.B., A. Krishnaraj, A.Q., S.V.), St. Michael's Hospital of Unity Health Toronto, ON, Canada.,School of Medicine, Royal College of Surgeons in Ireland, Dublin (Y.S., R.V., M.M.)
| | - William Barbour
- Division of Cardiac Surgery (P.P., H.T., T.M., E.O., Y.S., W.B., A.P., S.A., A. Kosmopoulos, R.V., M.M., E.B., A. Krishnaraj, A.Q., S.V.), St. Michael's Hospital of Unity Health Toronto, ON, Canada.,Department of Physiology and Pharmacology, Western University, London, ON, Canada (W.B., D.A.H.)
| | - Aryan Pasricha
- Division of Cardiac Surgery (P.P., H.T., T.M., E.O., Y.S., W.B., A.P., S.A., A. Kosmopoulos, R.V., M.M., E.B., A. Krishnaraj, A.Q., S.V.), St. Michael's Hospital of Unity Health Toronto, ON, Canada.,Department of Health & Exercise Science, Wake Forest University, Winston-Salem, NC (A.P.)
| | - Shamon Ahmed
- Division of Cardiac Surgery (P.P., H.T., T.M., E.O., Y.S., W.B., A.P., S.A., A. Kosmopoulos, R.V., M.M., E.B., A. Krishnaraj, A.Q., S.V.), St. Michael's Hospital of Unity Health Toronto, ON, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, Canada (P.P., S.A.)
| | - Andrew Kosmopoulos
- Division of Cardiac Surgery (P.P., H.T., T.M., E.O., Y.S., W.B., A.P., S.A., A. Kosmopoulos, R.V., M.M., E.B., A. Krishnaraj, A.Q., S.V.), St. Michael's Hospital of Unity Health Toronto, ON, Canada.,Temerty Faculty of Medicine (E.O., A. Kosmopoulos), University of Toronto, ON, Canada
| | - Raj Verma
- Division of Cardiac Surgery (P.P., H.T., T.M., E.O., Y.S., W.B., A.P., S.A., A. Kosmopoulos, R.V., M.M., E.B., A. Krishnaraj, A.Q., S.V.), St. Michael's Hospital of Unity Health Toronto, ON, Canada.,School of Medicine, Royal College of Surgeons in Ireland, Dublin (Y.S., R.V., M.M.)
| | - Michael Moroney
- Division of Cardiac Surgery (P.P., H.T., T.M., E.O., Y.S., W.B., A.P., S.A., A. Kosmopoulos, R.V., M.M., E.B., A. Krishnaraj, A.Q., S.V.), St. Michael's Hospital of Unity Health Toronto, ON, Canada.,School of Medicine, Royal College of Surgeons in Ireland, Dublin (Y.S., R.V., M.M.)
| | - Ehab Bakbak
- Division of Cardiac Surgery (P.P., H.T., T.M., E.O., Y.S., W.B., A.P., S.A., A. Kosmopoulos, R.V., M.M., E.B., A. Krishnaraj, A.Q., S.V.), St. Michael's Hospital of Unity Health Toronto, ON, Canada.,Department of Pharmacology and Toxicology (E.B., A. Krishnaraj, D.A.H., S.V.), University of Toronto, ON, Canada
| | - Aishwarya Krishnaraj
- Division of Cardiac Surgery (P.P., H.T., T.M., E.O., Y.S., W.B., A.P., S.A., A. Kosmopoulos, R.V., M.M., E.B., A. Krishnaraj, A.Q., S.V.), St. Michael's Hospital of Unity Health Toronto, ON, Canada.,Department of Pharmacology and Toxicology (E.B., A. Krishnaraj, D.A.H., S.V.), University of Toronto, ON, Canada
| | - Deepak L Bhatt
- Division of Cardiovascular Medicine, Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX (J.B.).,Department of Medicine, University of Mississippi, Jackson (J.B.)
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (M.N.K.)
| | - Carolyn S P Lam
- National Heart Centre Singapore (C.S.P.L.).,Division of Cardiology, Duke-National University of Singapore (C.S.P.L.).,Division of Cardiology, Department of Medicine, State University of Campinas (UNICAMP), São Paulo, Brazil (C.S.P.L.)
| | - David A Hess
- Division of Vascular Surgery (D.A.H.), St. Michael's Hospital of Unity Health Toronto, ON, Canada.,Department of Pharmacology and Toxicology (E.B., A. Krishnaraj, D.A.H., S.V.), University of Toronto, ON, Canada.,Department of Physiology and Pharmacology, Western University, London, ON, Canada (W.B., D.A.H.).,Molecular Medicine Research Laboratories, Robarts Research Institute, London, ON, Canada (D.A.H.)
| | | | - Myriam Lafreniere-Roula
- Applied Health Research Centre (M.L.-R., K.E.T.), St. Michael's Hospital of Unity Health Toronto, ON, Canada
| | - Kevin E Thorpe
- Applied Health Research Centre (M.L.-R., K.E.T.), St. Michael's Hospital of Unity Health Toronto, ON, Canada.,Dana Lana School of Public Health (K.E.T.), University of Toronto, ON, Canada
| | - Adrian Quan
- Division of Cardiac Surgery (P.P., H.T., T.M., E.O., Y.S., W.B., A.P., S.A., A. Kosmopoulos, R.V., M.M., E.B., A. Krishnaraj, A.Q., S.V.), St. Michael's Hospital of Unity Health Toronto, ON, Canada
| | - Lawrence A Leiter
- Division of Endocrinology and Metabolism (H.T., L.A.L.), St. Michael's Hospital of Unity Health Toronto, ON, Canada.,Department of Medicine (K.A.C., L.A.L., A.T.Y.), University of Toronto, ON, Canada.,Department of Nutritional Sciences (L.A.L.), University of Toronto, ON, Canada
| | - Andrew T Yan
- Division of Cardiology (K.A.C., F.A., A.T.Y.), St. Michael's Hospital of Unity Health Toronto, ON, Canada.,Department of Medicine (K.A.C., L.A.L., A.T.Y.), University of Toronto, ON, Canada
| | - Subodh Verma
- Division of Cardiac Surgery (P.P., H.T., T.M., E.O., Y.S., W.B., A.P., S.A., A. Kosmopoulos, R.V., M.M., E.B., A. Krishnaraj, A.Q., S.V.), St. Michael's Hospital of Unity Health Toronto, ON, Canada.,Department of Pharmacology and Toxicology (E.B., A. Krishnaraj, D.A.H., S.V.), University of Toronto, ON, Canada.,Department of Surgery (S.V.), University of Toronto, ON, Canada
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29
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Nazari S, Mirkhani H. Cardiorenal Protections of SGLT2 Inhibitors in the Treatment of Type 2 Diabetes. Curr Diabetes Rev 2023; 19:e221222212126. [PMID: 36567296 DOI: 10.2174/1573399819666221222160035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/16/2022] [Accepted: 10/31/2022] [Indexed: 12/27/2022]
Abstract
Cardiovascular disease and renal complications raise the risk of death and morbidity in patients with type 2 diabetes (T2D). Sodium/glucose cotransporter-2 inhibitors (SGLT2i) are a novel class of glucose-lowering drug that increases urine glucose excretion while decreasing blood glucose levels in type 2 diabetes patients by inhibiting glucose reabsorption. In the present article, we review the discovery and development of SGLT2i as a new T2D treatment approach for T2D; thereafter, we consider different cell-based methods for the evaluation of SGLT2i. Finally, we provide evidences from both clinical and experimental studies which bring up the cardio-renal protective effects of SGLT2i. We performed a literature search using PubMed, Google Scholar, and Web of Science to identify publications on preclinical and clinical studies of cardiorenal protective action of SGLT2i and their suggested mechanisms. SGLT2i have shown good effects in the improvement of cardiovascular and renal complications independent of glucose lowering effects. Besides controlling blood glucose levels, SGLT2i were found to exhibit therapeutic benefits on the kidney and cardiovascular system by lowering diabetic glomerular hyperfiltration, blood pressure (BP), body weight, uric acid concentrations, lipid peroxidation, inflammation, etc. As a result of their distinct mode of action, SGLT2i have emerged as a promising treatment option for T2D and maybe T1D due to their increased urine excretion of glucose. It has been demonstrated that SGLT2i have considerable protective effects on diabetic nephropathy (DN) and cardiomyopathy in well-designed experimental and clinical investigations.
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Affiliation(s)
- Somayeh Nazari
- Medicinal & Natural Products Chemistry Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Mirkhani
- Medicinal & Natural Products Chemistry Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pharmacology, Shiraz University of Medical Sciences, Shiraz, Iran
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Arslan K, Yılmaz E, Aydın E. Effects of sodium-glucose cotransporter-2 inhibitors on nutritional status in heart failure with reduced ejection fraction. Rev Assoc Med Bras (1992) 2022; 68:1576-1581. [PMID: 36449777 PMCID: PMC9720773 DOI: 10.1590/1806-9282.20220737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effects of sodium-glucose cotransporter-2 inhibitors on nutritional status in patients with heart failure with reduced ejection fraction. METHODS The sodium-glucose cotransporter-2 inhibitor treatment was initiated in 153 patients with heart failure with reduced ejection fraction who were symptomatic despite optimal medical treatment and were followed up for 6 months. The Minnesota Living With Heart Failure Questionnaire scores, New York Heart Association functional class, NT-pro-BNP levels, and nutritional index scores of the patients were evaluated before sodium-glucose cotransporter-2 inhibitor treatment and at the 6-month follow-up. The nutritional status of the patients was evaluated with the COntrolling NUTritional Status score, Geriatric Nutritional Risk Index, and Prognostic Nutritional Index. RESULTS After sodium-glucose cotransporter-2 inhibitor treatment, significant changes were observed in the mean scores of the three different nutritional indexes: COntrolling NUTritional Status (before: 2.76±2.43 vs. after: 1.12±1.23, p<0.001), Geriatric Nutritional Risk Index (before: 98.2±9.63 vs. after: 104.4±5.83, p<0.001), and Prognostic Nutritional Index (before: 37.9±4.63 vs. after: 42.9±3.83, p<0.001) scores. A significant decrease in the number of patients with malnutrition was observed according to the COntrolling NUTritional Status (before: 46.4% vs. after: 9.7%, p<0.001), Geriatric Nutritional Risk Index (before: 41.8% vs. after: 18.9%, p=0.006), and Prognostic Nutritional Index (before: 36.6% vs. after: 13.7%, p=0.007) scores. A significant functional improvement was observed in patients after sodium-glucose cotransporter-2 treatment: Minnesota Living With Heart Failure Questionnaire scores (before: 39.2±7.2 vs. after: 20.4±7.4, p<0.001), NT-pro-BNP levels (before: 2989±681 vs. after: 1236±760, p<0.001), and New York Heart Association class (before: class II-III: 95.5%; class IV: 4.5% vs. after: class II-III: 78%; class IV: 0%, p<0.001). CONCLUSION In patients with heart failure with reduced ejection fraction who are symptomatic despite optimal medical treatment, the addition of an sodium-glucose cotransporter-2 inhibitor to treatment can significantly improve both the nutritional and functional statuses.
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Affiliation(s)
- Kadem Arslan
- Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Department of Internal Medicine – İstanbul, Turkey
| | - Emre Yılmaz
- Giresun University, Medical School, Department of Cardiology – Giresun, Turkey
| | - Ercan Aydın
- Trabzon Kanuni Training and Research Hospital, Department of Cardiology – Trabzon, Turkey
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Chan ATP, Tang SCW. Advances in the management of diabetic kidney disease: beyond sodium-glucose co-transporter 2 inhibitors. Kidney Res Clin Pract 2022; 41:682-698. [PMID: 35977903 PMCID: PMC9731775 DOI: 10.23876/j.krcp.21.285] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/20/2022] [Accepted: 05/09/2022] [Indexed: 08/09/2023] Open
Abstract
Progress in the treatment of diabetic kidney disease (DKD) has been modest since the early trials on renin-angiotensin-aldosterone system inhibitors (RAASis). Although sodium-glucose co-transporter 2 inhibitors (SGLT2is) have revolutionized the management of DKD by lowering proteinuria and protecting organs, other novel treatment approaches with good evidence and efficacy that can be used in conjunction with a RAASi or SGLT2i in managing DKD have emerged in the past few years. This review discusses the evidence for glucagon-like peptide-1 receptor agonist, selective mineralocorticoid receptor antagonist, and selective endothelin A receptor antagonist, emerging treatment options for DKD beyond SGLT2 inhibition.
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Affiliation(s)
- Anthony T. P. Chan
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Sydney C. W. Tang
- Division of Nephrology, Department of Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Packer M. Critical Reanalysis of the Mechanisms Underlying the Cardiorenal Benefits of SGLT2 Inhibitors and Reaffirmation of the Nutrient Deprivation Signaling/Autophagy Hypothesis. Circulation 2022; 146:1383-1405. [PMID: 36315602 PMCID: PMC9624240 DOI: 10.1161/circulationaha.122.061732] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/10/2022] [Indexed: 02/06/2023]
Abstract
SGLT2 (sodium-glucose cotransporter 2) inhibitors produce a distinctive pattern of benefits on the evolution and progression of cardiomyopathy and nephropathy, which is characterized by a reduction in oxidative and endoplasmic reticulum stress, restoration of mitochondrial health and enhanced mitochondrial biogenesis, a decrease in proinflammatory and profibrotic pathways, and preservation of cellular and organ integrity and viability. A substantial body of evidence indicates that this characteristic pattern of responses can be explained by the action of SGLT2 inhibitors to promote cellular housekeeping by enhancing autophagic flux, an effect that may be related to the action of these drugs to produce simultaneous upregulation of nutrient deprivation signaling and downregulation of nutrient surplus signaling, as manifested by an increase in the expression and activity of AMPK (adenosine monophosphate-activated protein kinase), SIRT1 (sirtuin 1), SIRT3 (sirtuin 3), SIRT6 (sirtuin 6), and PGC1-α (peroxisome proliferator-activated receptor γ coactivator 1-α) and decreased activation of mTOR (mammalian target of rapamycin). The distinctive pattern of cardioprotective and renoprotective effects of SGLT2 inhibitors is abolished by specific inhibition or knockdown of autophagy, AMPK, and sirtuins. In the clinical setting, the pattern of differentially increased proteins identified in proteomics analyses of blood collected in randomized trials is consistent with these findings. Clinical studies have also shown that SGLT2 inhibitors promote gluconeogenesis, ketogenesis, and erythrocytosis and reduce uricemia, the hallmarks of nutrient deprivation signaling and the principal statistical mediators of the ability of SGLT2 inhibitors to reduce the risk of heart failure and serious renal events. The action of SGLT2 inhibitors to augment autophagic flux is seen in isolated cells and tissues that do not express SGLT2 and are not exposed to changes in environmental glucose or ketones and may be related to an ability of these drugs to bind directly to sirtuins or mTOR. Changes in renal or cardiovascular physiology or metabolism cannot explain the benefits of SGLT2 inhibitors either experimentally or clinically. The direct molecular effects of SGLT2 inhibitors in isolated cells are consistent with the concept that SGLT2 acts as a nutrient surplus sensor, and thus, its inhibition causes enhanced nutrient deprivation signaling and its attendant cytoprotective effects, which can be abolished by specific inhibition or knockdown of AMPK, sirtuins, and autophagic flux.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Dallas, TX. Imperial College, London, United Kingdom
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Jongs N, Chertow GM, Greene T, McMurray JJ, Langkilde AM, Correa-Rotter R, Kashihara N, Rossing P, Sjöström CD, Stefánsson BV, Toto RD, Wheeler DC, Heerspink HJ. Correlates and Consequences of an Acute Change in eGFR in Response to the SGLT2 Inhibitor Dapagliflozin in Patients with CKD. J Am Soc Nephrol 2022; 33:2094-2107. [PMID: 35977807 PMCID: PMC9678032 DOI: 10.1681/asn.2022030306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/18/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Dapagliflozin reduces kidney failure risk in patients with CKD but can result in a reversible acute reduction in eGFR upon treatment initiation. Determinants of this eGFR reduction and its associations with efficacy and safety outcomes are unknown. METHODS The DAPA-CKD trial randomized 4304 adults with CKD and albuminuria to once-daily dapagliflozin 10 mg or placebo, added to standard care. We prespecified an analysis comparing the effects of dapagliflozin among patients who experienced relative reductions in eGFR (>10% or >0%-10%) or an increase in eGFR from baseline to 2 weeks and assessed long-term efficacy and safety thereafter. RESULTS A total of 4157 (96.6%) patients had eGFR data available at baseline and at 2 weeks. In the dapagliflozin and placebo groups, 1026 (49.4%) and 494 (23.7%), respectively, experienced an acute reduction in eGFR >10%. Among patients receiving dapagliflozin, those with an acute reduction in eGFR >10% experienced a long-term eGFR decline of -1.58 ml/min per 1.73 m2 per year compared with -2.44 and -2.48 ml/min per 1.73 m2 per year among those experiencing a less pronounced reduction or increase in eGFR, respectively (P-interaction=0.05). In the placebo group, long-term eGFR decline was -3.27, -3.84, and -3.77 ml/min per 1.73 m2 per year for acute eGFR reduction subgroups of >10%, >0%-10%, or increase in eGFR (P-interaction=0.48). Rates of serious adverse events and adverse events of special interest in patients randomized to dapagliflozin were unrelated to the acute eGFR change. CONCLUSIONS Among patients with CKD and albuminuria treated with dapagliflozin, an acute reduction in eGFR (from baseline to 2 weeks) is not associated with higher rates of CKD progression.Clinical Trial registration number: A Study to Evaluate the Effect of Dapagliflozin on Renal Outcomes and Cardiovascular Mortality in Patients With Chronic Kidney Disease (Dapa-CKD) NCT03036150.
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Affiliation(s)
- Niels Jongs
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Glenn M. Chertow
- Departments of Medicine and Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA
| | - Tom Greene
- Study Design and Biostatistics Center, University of Utah Health Sciences, Salt Lake City, UT
| | - John J.V. McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Anna Maria Langkilde
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Ricardo Correa-Rotter
- The National Medical Science and Nutrition Institute Salvador Zubirán, Mexico City, Mexico
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - C. David Sjöström
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Bergur V. Stefánsson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Robert D. Toto
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - David C. Wheeler
- Department of Renal Medicine, University College London, London, United Kingdom
- The George Institute for Global Health, Sydney, Australia
| | - Hiddo J.L. Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- The George Institute for Global Health, Sydney, Australia
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Selvaraj S, Fu Z, Jones P, Kwee LC, Windsor SL, Ilkayeva O, Newgard CB, Margulies KB, Husain M, Inzucchi SE, McGuire DK, Pitt B, Scirica BM, Lanfear DE, Nassif ME, Javaheri A, Mentz RJ, Kosiborod MN, Shah SH. Metabolomic Profiling of the Effects of Dapagliflozin in Heart Failure With Reduced Ejection Fraction: DEFINE-HF. Circulation 2022; 146:808-818. [PMID: 35603596 PMCID: PMC9474658 DOI: 10.1161/circulationaha.122.060402] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/18/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Sodium-glucose cotransporter-2 inhibitors are foundational therapy in patients with heart failure with reduced ejection fraction (HFrEF), but underlying mechanisms of benefit are not well defined. We sought to investigate the relationships between sodium-glucose cotransporter-2 inhibitor treatment, changes in metabolic pathways, and outcomes using targeted metabolomics. METHODS DEFINE-HF (Dapagliflozin Effects on Biomarkers, Symptoms and Functional Status in Patients With HF With Reduced Ejection Fraction) was a placebo-controlled trial of dapagliflozin in HFrEF. We performed targeted mass spectrometry profiling of 63 metabolites (45 acylcarnitines [markers of fatty acid oxidation], 15 amino acids, and 3 conventional metabolites) in plasma samples at randomization and 12 weeks. Using mixed models, we identified principal components analysis-defined metabolite clusters that changed differentially with treatment and examined the relationship between change in metabolite clusters and change in Kansas City Cardiomyopathy Questionnaire scores and NT-proBNP (N-terminal probrain natriuretic peptide). Models were adjusted for relevant clinical covariates and nominal P<0.05 with false discovery rate-adjusted P<0.10 was used to determine statistical significance. RESULTS Among the 234 DEFINE-HF participants with targeted metabolomic data, the mean age was 62.0±11.1 years, 25% were women, 38% were Black, and mean ejection fraction was 27±8%. Dapagliflozin increased ketone-related and short-chain acylcarnitine as well as medium-chain acylcarnitine principal components analysis-defined metabolite clusters compared with placebo (nominal P=0.01, false discovery rate-adjusted P=0.08 for both clusters). However, ketosis (β-hydroxybutyrate levels >500 μmol/L) was achieved infrequently (3 [2.5%] in dapagliflozin arm versus 1 [0.9%] in placebo arm) and supraphysiologic levels were not observed. Increases in long-chain acylcarnitine, long-chain dicarboxylacylcarnitine, and aromatic amino acid metabolite clusters were associated with decreases in Kansas City Cardiomyopathy Questionnaire scores (ie, worse quality of life) and increases in NT-proBNP levels, without interaction by treatment group. CONCLUSIONS In this study of targeted metabolomics in a placebo-controlled trial of sodium-glucose cotransporter-2 inhibitors in HFrEF, we observed effects of dapagliflozin on key metabolic pathways, supporting a role for altered ketone and fatty acid biology with sodium-glucose cotransporter-2 inhibitors in patients with HFrEF. Only physiologic levels of ketosis were observed. In addition, we identified several metabolic biomarkers associated with adverse HFrEF outcomes. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02653482.
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Affiliation(s)
- Senthil Selvaraj
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Zhuxuan Fu
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
| | - Philip Jones
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
| | - Lydia C. Kwee
- Duke Molecular Physiology Institute, Durham, North Carolina
| | | | - Olga Ilkayeva
- Duke Molecular Physiology Institute, Durham, North Carolina
- Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Kenneth B. Margulies
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Mansoor Husain
- Ted Rogers Centre for Heart Research, University of Toronto, Canada
| | | | - Darren K. McGuire
- University of Texas Southwestern Medical Center and Parkland Health and Hospital System, Dallas, TX
| | - Bertram Pitt
- University of Michigan School of Medicine, Ann Arbor, MI
| | - Benjamin M. Scirica
- Cardiovascular Division, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - David E. Lanfear
- Center for Individualized and Genomic Medicine Research, Henry Ford Hospital, Detroit, Michigan; Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan
| | - Michael E. Nassif
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, MO
| | - Ali Javaheri
- Washington University School of Medicine, St. Louis, MO
| | - Robert J. Mentz
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Mikhail N. Kosiborod
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
- University of Missouri-Kansas City, MO
| | - Svati H. Shah
- Duke Molecular Physiology Institute, Durham, North Carolina
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Seo DH, Suh YJ, Cho Y, Ahn SH, Seo S, Hong S, Lee YH, Choi YJ, Lee E, Kim SH. Effect of Dapagliflozin in Combination with Lobeglitazone and Metformin in Korean Patients with Type 2 Diabetes in Real-World Clinical Practice. Yonsei Med J 2022; 63:825-833. [PMID: 36031782 PMCID: PMC9424781 DOI: 10.3349/ymj.2022.63.9.825] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aimed to evaluate the efficacy and tolerability of dapagliflozin as an add-on or a switch therapy to lobeglitazone plus metformin (MFM) in Korean patients with inadequately controlled type 2 diabetes mellitus (T2DM) in real-world clinical practice. MATERIALS AND METHODS The study included 109 patients who started dapagliflozin as add-on or switch therapy to lobeglitazone plus MFM. The primary outcome was a change in glycated hemoglobin (HbA1c) level from baseline after 12 months of treatment. Secondary outcomes included changes in fasting plasma glucose (FPG), lipid profiles, body weight, visceral fat area (VFA), and blood pressure after 12 months of treatment. RESULTS The baseline HbA1c was 8.3±1.3% (8.7±1.5% in the add-on group and 8.1±1.0% in the switch group). After 12 months, mean HbA1c decreased (-0.91%) in all patients (p<0.05) (-1.39% in the add-on group and -0.63% in the switch group). Significant reductions in FPG were also observed in both the add-on and switch groups (-54.37 mg/dL and -24.68 mg/dL, respectively). Overall, there was a significant improvement in serum triglyceride (-24.74 mg/dL), low density lipoprotein cholesterol (-7.92 mg/dL), body weight (-2.98 kg), VFA (-9.00 cm²), and systolic blood pressure (-8.67 mm Hg). Approximately 35.8% of patients achieved HbA1c <7.0% after 12 months. CONCLUSION Dapagliflozin, as an add-on or a switch therapy to lobeglitazone plus MFM, can be a suitable alternative for Korean patients with inadequately controlled T2DM. The combination therapy resulted in significant reductions in HbA1c levels, body weight, and blood pressure.
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Affiliation(s)
- Da Hea Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University College of Medicine, Incheon, Korea
| | - Yongin Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Seong Hee Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Seongha Seo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Seongbin Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Yong-Ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | | | - Eunjig Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - So Hun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.
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Cosentino F, Cannon CP, Frederich R, Cherney DZ, Dagogo-Jack S, Pratley RE, Mancuso JP, Maldonado M, Cater NB, Wang S, McGuire DK. Cardiorenal Outcomes With Ertugliflozin by Baseline Metformin Use: Post Hoc Analyses of the VERTIS CV Trial. Circulation 2022; 146:652-654. [PMID: 35994565 PMCID: PMC9390228 DOI: 10.1161/circulationaha.121.058294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Francesco Cosentino
- Unit of Cardiology, Karolinska Institute & Karolinska University Hospital, Stockholm, Sweden (F.C.)
| | - Christopher P. Cannon
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (C.P.C.)
| | | | | | | | | | | | | | | | - Shuai Wang
- Pfizer Inc., Groton, CT (J.P.M., S.W.).,Now with Cerevel Therapeutics, Cambridge, MA (S.W.)
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Abstract
BACKGROUND The cardiorenal effects of sodium-glucose cotransporter 2 inhibition (empagliflozin 25 mg QD) combined with angiotensin-converting enzyme inhibition (ramipril 10 mg QD) were assessed in this mechanistic study in patients with type 1 diabetes with potential renal hyperfiltration. METHODS Thirty patients (out of 31 randomized) completed this double-blind, placebo-controlled, crossover trial. Recruitment was stopped early because of an unexpectedly low proportion of patients with hyperfiltration. Measurements were obtained after each of the 6 treatment phases over 19 weeks: (1) baseline without treatment, (2) 4-week run-in with ramipril treatment alone, (3) 4-week combined empagliflozin-ramipril treatment, (4) a 4-week washout, (5) 4-week combined placebo-ramipril treatment, and (6) 1-week follow-up. The primary end point was glomerular filtration rate (GFR) after combination treatment with empagliflozin-ramipril compared with placebo-ramipril. GFR was corrected for ramipril treatment alone before randomization. At the end of study phase, the following outcomes were measured under clamped euglycemia (4 to 6 mmol/L): inulin (GFR) and para-aminohippurate (effective renal plasma flow) clearances, tubular sodium handling, ambulatory blood pressure, arterial stiffness, heart rate variability, noninvasive cardiac output monitoring, plasma and urine biochemistry, markers of the renin-angiotensin-aldosterone system, and oxidative stress. RESULTS Combination treatment with empagliflozin-ramipril resulted in an 8 mL/min/1.73 m2 lower GFR compared with placebo-ramipril treatment (P=0.0061) without significant changes to effective renal plasma flow. GFR decrease was accompanied by a 21.3 mL/min lower absolute proximal fluid reabsorption rate (P=0.0092), a 3.1 mmol/min lower absolute proximal sodium reabsorption rate (P=0.0056), and a 194 ng/mmol creatinine lower urinary 8-isoprostane level (P=0.0084) relative to placebo-ramipril combination treatment. Sodium-glucose cotransporter 2 inhibitor/angiotensin-converting enzyme inhibitor combination treatment resulted in additive blood pressure-lowering effects (clinic systolic blood pressure lower by 4 mm Hg [P=0.0112]; diastolic blood pressure lower by 3 mm Hg [P=0.0032]) in conjunction with a 94.5 dynes × sex/cm5 lower total peripheral resistance (P=0.0368). There were no significant changes observed to ambulatory blood pressure, arterial stiffness, heart rate variability, or cardiac output with the addition of empagliflozin. CONCLUSIONS Adding sodium-glucose cotransporter 2 inhibitor treatment to angiotensin-converting enzyme inhibitor resulted in an expected GFR dip, suppression of oxidative stress markers, additive declines in blood pressure and total peripheral resistance. These changes are consistent with a protective physiologic profile characterized by the lowering of intraglomerular pressure and related cardiorenal risk when adding a sodium-glucose cotransporter 2 inhibitor to conservative therapy. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02632747.
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Affiliation(s)
- Yuliya Lytvyn
- Department of Medicine, Division of Nephrology, Toronto General Hospital (Y.L., V.L., J.T., L.C., D.Z.I.C.),Temerty Faculty of Medicine (Y.L.)
| | - Karen Kimura
- Boehringer Ingelheim Canada Ltd/Ltée, Burlington (K.K.)
| | | | - Vesta Lai
- Department of Medicine, Division of Nephrology, Toronto General Hospital (Y.L., V.L., J.T., L.C., D.Z.I.C.)
| | - Josephine Tse
- Department of Medicine, Division of Nephrology, Toronto General Hospital (Y.L., V.L., J.T., L.C., D.Z.I.C.)
| | - Leslie Cham
- Department of Medicine, Division of Nephrology, Toronto General Hospital (Y.L., V.L., J.T., L.C., D.Z.I.C.)
| | - Bruce A. Perkins
- Department of Medicine, Division of Endocrinology and Metabolism, Mount Sinai Hospital, University of Toronto, Canada (B.A.P.)
| | | | - David Z.I. Cherney
- Department of Medicine, Division of Nephrology, Toronto General Hospital (Y.L., V.L., J.T., L.C., D.Z.I.C.)
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Adamson C, Docherty KF, Heerspink HJ, de Boer RA, Damman K, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, Petrie MC, Ponikowski P, Sabatine MS, Schou M, Solomon SD, Verma S, Bengtsson O, Langkilde AM, Sjöstrand M, Vaduganathan M, Jhund PS, McMurray JJ. Initial Decline (Dip) in Estimated Glomerular Filtration Rate After Initiation of Dapagliflozin in Patients With Heart Failure and Reduced Ejection Fraction: Insights From DAPA-HF. Circulation 2022; 146:438-449. [PMID: 35442064 PMCID: PMC9354593 DOI: 10.1161/circulationaha.121.058910] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND In a post hoc analysis, the frequency of occurrence of an early decline (dip) in estimated glomerular filtration rate (eGFR) after initiation of dapagliflozin and its association with outcomes were evaluated in patients with heart failure and reduced ejection fraction randomized in the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial. METHODS Patients with heart failure with reduced ejection fraction with or without type 2 diabetes and an eGFR ≥30 mL·min-1·1.73 m-2 were randomized to placebo or dapagliflozin 10 mg daily. The primary outcome was the composite of worsening heart failure or cardiovascular death. The extent of the dip in eGFR between baseline and 2 weeks, patient characteristics associated with a >10% decline, and cardiovascular outcomes and eGFR slopes in participants experiencing this decline were investigated. Time-to-event outcomes were assessed in Cox regression from 14 days; eGFR slopes were assessed with repeated-measures mixed-effect models. RESULTS The mean change in eGFR between day 0 and 14 was -1.1 mL·min-1·1.73 m-2 (95% CI, -1.5 to -0.7) with placebo and -4.2 mL·min-1·1.73 m-2 (95% CI, -4.6 to -3.9) with dapagliflozin, giving a between-treatment difference of 3.1 mL·min-1·1.73 m-2 (95% CI, 2.6-3.7). The proportions of patients randomized to dapagliflozin experiencing a >10%, >20%, and >30% decline in eGFR were 38.2%, 12.6%, and 3.4%, respectively; for placebo, they were 21.0%, 6.4%, and 1.3%, respectively. The odds ratio for a >10% early decline in eGFR with dapagliflozin compared with placebo was 2.36 (95% CI, 2.07-2.69; P<0.001). Baseline characteristics associated with a >10% decline in eGFR on dapagliflozin were older age, lower eGFR, higher ejection fraction, and type 2 diabetes. The hazard ratio for the primary outcome in patients in the placebo group experiencing a >10% decline in eGFR compared with ≤10% decline in eGFR was 1.45 (95% CI, 1.19-1.78). The corresponding hazard ratio in the dapagliflozin group was 0.73 (95% CI, 0.59-0.91; Pinteraction<0.001). A >10% initial decline in eGFR was not associated with greater long-term decline in eGFR or more adverse events. CONCLUSIONS The average dip in eGFR after dapagliflozin was started was small and associated with better clinical outcomes compared with a similar decline on placebo in patients with heart failure with reduced ejection fraction. Large declines in eGFR were uncommon with dapagliflozin. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03036124.
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Affiliation(s)
- Carly Adamson
- BHF Cardiovascular Research Centre, University of Glasgow, UK (C.A., K.F.D., M.C.P., P.S.J., J.J.V.M.)
| | - Kieran F. Docherty
- BHF Cardiovascular Research Centre, University of Glasgow, UK (C.A., K.F.D., M.C.P., P.S.J., J.J.V.M.)
| | - Hiddo J.L. Heerspink
- Department of Clinical Pharmacy and Pharmacology (H.J.L.H.), University Medical Center Groningen, University of Groningen, The Netherlands
| | - Rudolf A. de Boer
- Department of Cardiology (R.A.d.B., K.D.), University Medical Center Groningen, University of Groningen, The Netherlands
| | - Kevin Damman
- Department of Cardiology (R.A.d.B., K.D.), University Medical Center Groningen, University of Groningen, The Netherlands
| | - Silvio E. Inzucchi
- Section of Endocrinology, Yale School of Medicine, New Haven, CT (S.E.I.)
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (L.K.)
| | - Mikhail N. Kosiborod
- Saint Luke’s Mid America Heart Institute, University of Missouri, Kansas City (M.N.K.)
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (M.N.K.)
| | | | - Mark C. Petrie
- BHF Cardiovascular Research Centre, University of Glasgow, UK (C.A., K.F.D., M.C.P., P.S.J., J.J.V.M.)
| | - Piotr Ponikowski
- Center for Heart Diseases, University Hospital, Wroclaw Medical University, Poland (P.P.)
| | - Marc S. Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (M.S.S.)
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark (M. Schou)
| | - Scott D. Solomon
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (S.D.S., M.V.)
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael’s Hospital, University of Toronto, Ontario, Canada (S.V.)
| | - Olof Bengtsson
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (O.B., A.M.L., M. Sjöstrand)
| | - Anna Maria Langkilde
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (O.B., A.M.L., M. Sjöstrand)
| | - Mikaela Sjöstrand
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (O.B., A.M.L., M. Sjöstrand)
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (S.D.S., M.V.)
| | - Pardeep S. Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, UK (C.A., K.F.D., M.C.P., P.S.J., J.J.V.M.)
| | - John J.V. McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, UK (C.A., K.F.D., M.C.P., P.S.J., J.J.V.M.)
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Jensen J, Omar M, Kistorp C, Tuxen C, Poulsen MK, Faber J, Køber L, Gustafsson F, Møller JE, Schou M. Effect of Empagliflozin on Multiple Biomarkers in Heart Failure: Insights From the Empire Heart Failure Trial. Circ Heart Fail 2022; 15:e009333. [PMID: 35973031 DOI: 10.1161/circheartfailure.121.009333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jesper Jensen
- Department of Cardiology (J.J., M.S.), Herlev and Gentofte University Hospital, Denmark
| | - Massar Omar
- Department of Cardiology, Odense University Hospital, Denmark (M.O., M.K.P., J.E.M.).,Steno Diabetes Center Odense, Denmark (M.O.).,Faculty of Health Sciences, University of Southern Denmark, Odense (M.O., J.E.M.)
| | - Caroline Kistorp
- Department of Endocrinology (C.K.), Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (C.K., J.F., L.K., F.G., M.S.)
| | - Christian Tuxen
- Department of Cardiology, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark (C.T.)
| | - Mikael Kjær Poulsen
- Department of Cardiology, Odense University Hospital, Denmark (M.O., M.K.P., J.E.M.)
| | - Jens Faber
- Department of Internal Medicine, Center of Endocrinology and Metabolism (J.F.), Herlev and Gentofte University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (C.K., J.F., L.K., F.G., M.S.)
| | - Lars Køber
- Department of Cardiology (L.K., F.G., J.E.M.), Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (C.K., J.F., L.K., F.G., M.S.)
| | - Finn Gustafsson
- Department of Cardiology (L.K., F.G., J.E.M.), Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (C.K., J.F., L.K., F.G., M.S.)
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, Denmark (M.O., M.K.P., J.E.M.).,Department of Cardiology (L.K., F.G., J.E.M.), Rigshospitalet, Copenhagen, Denmark.,Faculty of Health Sciences, University of Southern Denmark, Odense (M.O., J.E.M.)
| | - Morten Schou
- Department of Cardiology (J.J., M.S.), Herlev and Gentofte University Hospital, Denmark.,Department of Clinical Medicine, University of Copenhagen, Denmark (C.K., J.F., L.K., F.G., M.S.)
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40
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Mone P, Varzideh F, Jankauskas SS, Pansini A, Lombardi A, Frullone S, Santulli G. SGLT2 Inhibition via Empagliflozin Improves Endothelial Function and Reduces Mitochondrial Oxidative Stress: Insights From Frail Hypertensive and Diabetic Patients. Hypertension 2022; 79:1633-1643. [PMID: 35703100 PMCID: PMC9642044 DOI: 10.1161/hypertensionaha.122.19586] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Frailty is a multidimensional condition often diagnosed in older adults with hypertension and diabetes, and both these conditions are associated with endothelial dysfunction and oxidative stress. We investigated the functional role of the SGLT2 (sodium glucose cotransporter 2) inhibitor empagliflozin in frail diabetic and hypertensive older adults. METHODS We studied the effects of empagliflozin in consecutive hypertensive and diabetic older patients with frailty presenting at the ASL (local health unit of the Italian Ministry of Health) of Avellino, Italy, from March 2021 to January 2022. Moreover, we performed in vitro experiments in human endothelial cells to measure cell viability, permeability, mitochondrial Ca2+, and oxidative stress. RESULTS We evaluated 407 patients; 325 frail elders with diabetes successfully completed the study. We propensity-score matched 75 patients treated with empagliflozin and 75 with no empagliflozin. We observed a correlation between glycemia and Montreal Cognitive Assessment (MoCA) score and between glycemia and 5-meter gait speed (5mGS). At 3-month follow-up, we detected a significant improvement in the MoCA score and in the 5mGS in patients receiving empagliflozin compared with non-treated subjects. Mechanistically, we demonstrate that empagliflozin significantly reduces mitochondrial Ca2+ overload and reactive oxygen species production triggered by high glucose in human endothelial cells, attenuates cellular permeability, and improves cell viability in response to oxidative stress. CONCLUSIONS Taken together, our data indicate that empagliflozin reduces frailty in diabetic and hypertensive patients, most likely by decreasing the mitochondrial generation of reactive oxygen species in endothelial cells.
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Affiliation(s)
- Pasquale Mone
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, New York, NY,Asl Avellino,Corresponding Author: Prof. Gaetano Santulli, MD, PhD () or Dr. Pasquale Mone, MD () Address: 1300 Morris PARK AVENUE, 10461 New York, NY
| | - Fahimeh Varzideh
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, New York, NY
| | | | | | - Angela Lombardi
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, New York, NY
| | | | - Gaetano Santulli
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, New York, NY,Department of Molecular Pharmacology, Albert Einstein College of Medicine, New York, NY.,Corresponding Author: Prof. Gaetano Santulli, MD, PhD () or Dr. Pasquale Mone, MD () Address: 1300 Morris PARK AVENUE, 10461 New York, NY
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Lee MMY, Gillis KA, Brooksbank KJM, Allwood-Spiers S, Hall Barrientos P, Wetherall K, Roditi G, AlHummiany B, Berry C, Campbell RT, Chong V, Coyle L, Docherty KF, Dreisbach JG, Kuehn B, Labinjoh C, Lang NN, Lennie V, Mangion K, McConnachie A, Murphy CL, Petrie CJ, Petrie JR, Sharma K, Sourbron S, Speirits IA, Thompson J, Welsh P, Woodward R, Wright A, Radjenovic A, McMurray JJV, Jhund PS, Petrie MC, Sattar N, Mark PB. Effect of Empagliflozin on Kidney Biochemical and Imaging Outcomes in Patients With Type 2 Diabetes, or Prediabetes, and Heart Failure with Reduced Ejection Fraction (SUGAR-DM-HF). Circulation 2022; 146:364-367. [PMID: 35877829 DOI: 10.1161/circulationaha.122.059851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Matthew M Y Lee
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
- Glasgow Royal Infirmary, UK (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.)
| | - Keith A Gillis
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Katriona J M Brooksbank
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Sarah Allwood-Spiers
- Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, UK (S.A.-S., P.H.B.)
| | - Pauline Hall Barrientos
- Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, UK (S.A.-S., P.H.B.)
| | - Kirsty Wetherall
- Robertson Centre for Biostatistics (K.W., A.M.), University of Glasgow, UK
| | - Giles Roditi
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
- Glasgow Royal Infirmary, UK (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.)
| | | | - Colin Berry
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Ross T Campbell
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Victor Chong
- University Hospital Crosshouse, Kilmarnock, UK (V.C.)
| | | | - Kieran F Docherty
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | | | - Bernd Kuehn
- Siemens Healthcare GmbH, Erlangen, Germany (B.K.)
| | | | - Ninian N Lang
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Vera Lennie
- University Hospital Ayr, UK (V.L.)
- Aberdeen Royal Infirmary, UK (V.L.)
| | - Kenneth Mangion
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Alex McConnachie
- Robertson Centre for Biostatistics (K.W., A.M.), University of Glasgow, UK
| | | | - Colin J Petrie
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- University Hospital Monklands, Airdrie, UK (C.J.P.)
| | - John R Petrie
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Glasgow Royal Infirmary, UK (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.)
| | | | - Steven Sourbron
- University of Leeds, UK (B.A., S.S.)
- University of Sheffield, UK (K.S., S.S.)
| | | | - Joyce Thompson
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Paul Welsh
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
| | - Rosemary Woodward
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Ann Wright
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Aleksandra Radjenovic
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Pardeep S Jhund
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Glasgow Royal Infirmary, UK (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.)
- University Hospital Crosshouse, Kilmarnock, UK (V.C.)
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Glasgow Royal Infirmary, UK (M.M.Y.L., G.R., J.R.P., M.C.P., N.S.)
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences (M.M.Y.L., K.A.G., K.J.M.B., G.R., C.B., R.T.C., L.C., K.F.D., N.N.L., K.M., C.J.P., J.R.P., P.W., A.W., A.R., J.J.V.M., P.S.J., M.C.P., N.S., P.B.M.), University of Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK (M.M.Y.L., K.A.G., G.R., C.B., R.T.C., K.F.D., N.N.L., K.M., J.T., R.W., A.W., J.J.V.M., P.S.J., P.B.M.)
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42
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Dobre M. Safety of SGLT2 Inhibitors in CKD: Walking the Fine Line. Clin J Am Soc Nephrol 2022; 17:774-776. [PMID: 35618341 PMCID: PMC9269644 DOI: 10.2215/cjn.04900422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Mirela Dobre
- Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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43
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Cowan A, Jeyakumar N, Kang Y, Dixon SN, Garg AX, Naylor K, Weir MA, Clemens KK. Fracture Risk of Sodium-Glucose Cotransporter-2 Inhibitors in Chronic Kidney Disease. Clin J Am Soc Nephrol 2022; 17:835-842. [PMID: 35618342 PMCID: PMC9269654 DOI: 10.2215/cjn.16171221] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/11/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been associated with a higher risk of skeletal fractures in some randomized, placebo-controlled trials. Secondary hyperparathyroidism and increased bone turnover (also common in CKD) may contribute to the observed fracture risk. We aimed to determine if SGLT2 inhibitor use associates with a higher risk of fractures compared with dipeptidyl peptidase-4 (DPP-4) inhibitors, which have no known association with fracture risk. We hypothesized that this risk, if present, would be greatest in patients with lower eGFR. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a population-based cohort study in Ontario, Canada between 2015 and 2019 using linked provincial administrative data to compare the incidence of fracture between new users of SGLT2 inhibitors and DPP-4 inhibitors. We used inverse probability of treatment weighting on the basis of propensity scores to balance the two groups of older adults (≥66 years of age) on indicators of baseline health. We compared the 180- and 365-day cumulative incidence rates of fracture between groups. Prespecified subgroup analyses were conducted by eGFR category (≥90, 60 to <90, 45 to <60, and 30 to <45 ml/min per 1.73 m2). Weighted hazard ratios were obtained using Cox proportional hazard regression. RESULTS After weighting, we identified a total of 38,994 new users of a SGLT2 inhibitor and 37,449 new users of a DPP-4 inhibitor and observed a total of 342 fractures at 180 days and 689 fractures at 365 days. The weighted 180- and 365-day risks of a fragility fracture did not significantly differ between new users of a SGLT2 inhibitor versus a DPP-4 inhibitor: weighted hazard ratio, 0.95 (95% confidence interval, 0.79 to 1.13) and weighted hazard ratio, 0.88 (95% confidence interval, 0.88 to 1.00), respectively. There was no observed interaction between fracture risk and eGFR category (P=0.53). CONCLUSIONS In this cohort study of older adults, starting a SGLT2 inhibitor versus DPP-4 inhibitor was not associated with a higher risk of skeletal fracture, regardless of eGFR.
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Affiliation(s)
- Andrea Cowan
- Institute for Clinical and Evaluative Sciences (ICES), London, Ontario, Canada .,Department of Medicine, Western University, London, Ontario, Canada
| | - Nivethika Jeyakumar
- Institute for Clinical and Evaluative Sciences (ICES), London, Ontario, Canada
| | - Yuguang Kang
- Institute for Clinical and Evaluative Sciences (ICES), London, Ontario, Canada
| | - Stephanie N Dixon
- Institute for Clinical and Evaluative Sciences (ICES), London, Ontario, Canada.,Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Amit X Garg
- Institute for Clinical and Evaluative Sciences (ICES), London, Ontario, Canada.,Department of Medicine, Western University, London, Ontario, Canada.,Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Kyla Naylor
- Institute for Clinical and Evaluative Sciences (ICES), London, Ontario, Canada
| | - Matthew A Weir
- Institute for Clinical and Evaluative Sciences (ICES), London, Ontario, Canada.,Department of Medicine, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Kristin K Clemens
- Institute for Clinical and Evaluative Sciences (ICES), London, Ontario, Canada.,Department of Medicine, Western University, London, Ontario, Canada.,Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,St. Joseph's Health Care London, London, Ontario, Canada
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44
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Claudel SE, Schmidt IM, Verma A. A Call for Implementation Science: Achieving Equitable Access to SGLT2 Inhibitors. Kidney360 2022; 3:942-944. [PMID: 36128478 PMCID: PMC9438421 DOI: 10.34067/kid.0001512022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Sophie E Claudel
- Department of Internal Medicine, Boston Medical Center, Boston, Massachusetts
| | - Insa M Schmidt
- Section of Nephrology, Department of Internal Medicine, Boston Medical Center, Boston, Massachusetts
| | - Ashish Verma
- Section of Nephrology, Department of Internal Medicine, Boston Medical Center, Boston, Massachusetts
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45
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Neuen BL, Oshima M, Agarwal R, Arnott C, Cherney DZ, Edwards R, Langkilde AM, Mahaffey KW, McGuire DK, Neal B, Perkovic V, Pong A, Sabatine MS, Raz I, Toyama T, Wanner C, Wheeler DC, Wiviott SD, Zinman B, Heerspink HJL. Sodium-Glucose Cotransporter 2 Inhibitors and Risk of Hyperkalemia in People With Type 2 Diabetes: A Meta-Analysis of Individual Participant Data From Randomized, Controlled Trials. Circulation 2022; 145:1460-1470. [PMID: 35394821 DOI: 10.1161/circulationaha.121.057736] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hyperkalemia increases risk of cardiac arrhythmias and death and limits the use of renin-angiotensin-aldosterone system inhibitors and mineralocorticoid receptor antagonists, which improve clinical outcomes in people with chronic kidney disease or systolic heart failure. Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of cardiorenal events in people with type 2 diabetes at high cardiovascular risk or with chronic kidney disease. However, their effect on hyperkalemia has not been systematically evaluated. METHODS A meta-analysis was conducted using individual participant data from randomized, double-blind, placebo-controlled clinical outcome trials with SGLT2 inhibitors in people with type 2 diabetes at high cardiovascular risk or with chronic kidney disease in whom serum potassium levels were routinely measured. The primary outcome was time to serious hyperkalemia, defined as central laboratory-determined serum potassium ≥6.0 mmol/L, with other outcomes including investigator-reported hyperkalemia events and hypokalemia (serum potassium ≤3.5 mmol/L). Cox regression analyses were performed to estimate treatment effects from each trial with hazards ratios and corresponding 95% CIs pooled with random-effects models to obtain summary treatment effects, overall and across key subgroups. RESULTS Results from 6 trials were included comprising 49 875 participants assessing 4 SGLT2 inhibitors. Of these, 1754 participants developed serious hyperkalemia, and an additional 1119 investigator-reported hyperkalemia events were recorded. SGLT2 inhibitors reduced the risk of serious hyperkalemia (hazard ratio, 0.84 [95% CI, 0.76-0.93]), an effect consistent across studies (Pheterogeneity=0.71). The incidence of investigator-reported hyperkalemia was also lower with SGLT2 inhibitors (hazard ratio, 0.80 [95% CI, 0.68-0.93]; Pheterogeneity=0.21). Reductions in serious hyperkalemia were observed across a range of subgroups, including baseline kidney function, history of heart failure, and use of renin-angiotensin-aldosterone system inhibitor, diuretic, and mineralocorticoid receptor antagonist. SGLT2 inhibitors did not increase the risk of hypokalemia (hazard ratio, 1.04 [95% CI, 0.94-1.15]; Pheterogeneity=0.42). CONCLUSIONS SGLT2 inhibitors reduce the risk of serious hyperkalemia in people with type 2 diabetes at high cardiovascular risk or with chronic kidney disease without increasing the risk of hypokalemia.
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Affiliation(s)
- Brendon L Neuen
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (B.L.N., C.A.)
| | - Megumi Oshima
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Japan (M.O., T.T.)
| | - Rajiv Agarwal
- Indiana University School of Medicine and VA Medical Center, Indianapolis (R.A.)
| | - Clare Arnott
- The George Institute for Global Health, University of New South Wales, Sydney, Australia (B.L.N., C.A.).,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia (C.A.).,Sydney Medical School, University of Sydney, Australia (C.A.)
| | - David Z Cherney
- Department of Medicine and Department of Physiology, Division of Nephrology, University Health Network, University of Toronto, Ontario, Canada (D.Z.C.)
| | | | | | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Stanford University School of Medicine, CA (K.W.M.)
| | - Darren K McGuire
- Department of Internal Medicine, University of Texas Southwestern Medical Center, and Parkland Health and Hospital System, Dallas (D.K.M.)
| | - Bruce Neal
- The Charles Perkins Centre, University of Sydney, Australia (B.N.).,Department of Epidemiology and Biostatistics, Imperial College London, UK (B.N.)
| | - Vlado Perkovic
- Faculty of Medicine, University of New South Wales, Sydney, Australia (V.P.)
| | | | - Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.S.S., S.D.W.)
| | - Itamar Raz
- Diabetes Unit, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel (I.R.)
| | | | - Christoph Wanner
- Division of Nephrology, Department of Medicine, Würzburg University Clinic, Germany (C.W.)
| | - David C Wheeler
- Department of Renal Medicine, UCL Medical School, London, UK (D.C.W.)
| | - Stephen D Wiviott
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (M.S.S., S.D.W.)
| | - Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Ontario, Canada (B.Z.)
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, the Netherlands (H.J.L.H.)
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46
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Harrington J, Mentz RJ. Prioritizing Quad Therapy and the Path Forward in Guideline-Directed Medical Therapy for Patients With Heart Failure With Reduced Ejection Fraction. Circulation 2022; 145:1105-1107. [PMID: 35404676 DOI: 10.1161/circulationaha.121.058595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Josephine Harrington
- Duke University School of Medicine (J.H., R.J.M.), Durham, NC.,Duke Clinical Research Institute (J.H., R.J.M.), Durham, NC
| | - Robert J Mentz
- Duke University School of Medicine (J.H., R.J.M.), Durham, NC.,Duke Clinical Research Institute (J.H., R.J.M.), Durham, NC
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47
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Kaku K, Yamamoto K, Fukushima Y, Mizuno S, Nitta D. Safety and effectiveness of empagliflozin according to body mass index in Japanese patients with type 2 diabetes: a subgroup analysis of a 3-year post-marketing surveillance study. Expert Opin Drug Saf 2022; 21:1411-1422. [PMID: 35379060 DOI: 10.1080/14740338.2022.2062322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Empagliflozin, a glucose-lowering drug licensed for type 2 diabetes (T2D), demonstrated tolerability and effectiveness overall in a post-marketing surveillance (PMS) study in Japan. However, the impact of body mass index (BMI) is unclear. RESEARCH DESIGN AND METHODS This was a prespecified sub-analysis of the prospective, 3-year, PMS study of empagliflozin in Japan where the primary endpoint was adverse drug reactions (ADRs). We evaluated results according to BMI. RESULTS We enrolled 7931 T2D patients treated with empagliflozin. Baseline mean age was 58.7 years; 63.01% were male. Baseline BMI was <20 kg/m2 in 2.06% of patients, while 21.28%, 37.35%, and 24.97% had BMI 20-<25, 25-<30 and ≥30 kg/m2, respectively. ADRs occurred in 19 (11.66%), 203 (12.03%), 411 (13.88%), and 295 (14.90%) patients with BMI <20, 20-<25, 25-<30 and ≥30 kg/m2, respectively. Excessive/frequent urination was the most frequent ADR of special interest in all BMI subgroups except 20-<25 kg/m2 (urinary tract infection). Mean change in glycated hemoglobin from baseline was -0.75%, with similar magnitude across BMI subgroups. Body-weight reduction seemed dependent on BMI, with almost no change in the <20 kg/m2 subgroup. CONCLUSIONS Empagliflozin appeared well tolerated and effective in Japanese T2D patients regardless of BMI, although the number of patients with BMI <20 kg/m2 was small in this study.
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Affiliation(s)
- Kohei Kaku
- Department of Medicine, Kawasaki Medical School, Okayama, Japan
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine, and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yumiko Fukushima
- Medicine Division, Nippon Boehringer Ingelheim Co. Ltd., Tokyo, Japan
| | | | - Daisuke Nitta
- Medicine Division, Nippon Boehringer Ingelheim Co. Ltd., Tokyo, Japan
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48
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Hamblin PS, Wong R, Ekinci EI, Sztal-Mazer S, Balachandran S, Frydman A, Hanrahan TP, Hu R, Ket SN, Moss A, Ng M, Ragunathan S, Bach LA. Body mass index is inversely associated with capillary ketones at the time of colonoscopy: Implications for SGLT2i use. Clin Endocrinol (Oxf) 2022; 96:549-557. [PMID: 34697809 DOI: 10.1111/cen.14621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/18/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been associated with diabetic ketoacidosis at the time of colonoscopy. This study aimed to identify factors associated with ketone concentrations in SGLT2i-treated type 2 diabetes compared with non-SGLT2i-treated diabetes, and those with impaired fasting glycaemia (IFG) and normoglycaemia. DESIGN Cross-sectional, multicentre, observational study June-December 2020 in four Australian tertiary hospitals. PARTICIPANTS Capillary glucose and ketones were measured in people undergoing colonoscopy: 37 SGLT2i-treated and 105 non-SGLT2i-treated type 2 diabetes, 65 IFG and 151 normoglycaemia. MEASUREMENTS Body mass index (BMI), age, glucose, fasting duration and where relevant, HbA1c and time since last SGLT2i dose. RESULTS In SGLT2i-treated diabetes, BMI (ρ = -0.43 [95% confidence interval: -0.67, -0.11]) and duration since last SGLT2i dose (ρ = -0.33 [-0.60, 0.00]) correlated negatively with increasing ketones, but there was no correlation with fasting duration. In non-SGLT2i-treated diabetes, BMI correlated negatively (ρ = -0.24 [-0.42, -0.05]) and fasting duration positively (ρ = 0.26 [0.07, 0.43]) with ketones. In IFG participants, only fasting duration correlated with ketones (ρ = 0.28 [0.03, 0.49]). In normoglycaemic participants, there were negative correlations with BMI (ρ = -0.20 [-0.35, -0.04]) and fasting glucose (ρ = -0.31 [-0.45, -0.15]) and positive correlations with fasting duration (ρ = 0.20 [0.04, 0.35]) and age (ρ = 0.19 [0.03, 0.34]). Multiple regression analysis of the entire cohort showed BMI, age and fasting glucose remained independently associated with ketones, but in SGLT2i-treated participants only BMI remained independently associated. CONCLUSIONS In SGLT2i-treated diabetes, lower BMI was a novel risk factor for higher ketones precolonoscopy. Pending larger confirmatory studies, extra vigilance for ketoacidosis is warranted in these people.
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Affiliation(s)
- Peter S Hamblin
- Department of Endocrinology and Diabetes, Western Health, Melbourne, Victoria, Australia
- Department of Medicine, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rosemary Wong
- Department of Endocrinology and Diabetes, Eastern Health, Melbourne, Victoria, Australia
- Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Elif I Ekinci
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shoshana Sztal-Mazer
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | | | - Aviva Frydman
- Department of Endocrinology and Diabetes, Western Health, Melbourne, Victoria, Australia
| | - Timothy P Hanrahan
- Department of Gastroenterology and Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia
| | - Raymond Hu
- Department of Medicine, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Anaesthesia, Austin Health, Melbourne, Victoria, Australia
| | - Shara N Ket
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
| | - Alan Moss
- Department of Medicine, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Endoscopic Services, Western Health, Melbourne, Victoria, Australia
| | - Mark Ng
- Department of Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Anaesthesia, Pain and Perioperative Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Sashikala Ragunathan
- Department of Gastroenterology, Austin Health, Melbourne, Victoria, Australia
- Gastroenterological Nurses College of Australia, Melbourne, Victoria, Australia
| | - Leon A Bach
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia
- Department of Medicine (Alfred), Monash University, Melbourne, Victoria, Australia
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49
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Hegyi B, Mira Hernandez J, Shen EY, Habibi NR, Bossuyt J, Bers DM. Empagliflozin Reverses Late Na + Current Enhancement and Cardiomyocyte Proarrhythmia in a Translational Murine Model of Heart Failure With Preserved Ejection Fraction. Circulation 2022; 145:1029-1031. [PMID: 35344407 PMCID: PMC8969782 DOI: 10.1161/circulationaha.121.057237] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Bence Hegyi
- Department of Pharmacology, University of California, Davis (B.H., J.M.H., E.Y.S., N.R.H., J.B., D.M.B.)
| | - Juliana Mira Hernandez
- Department of Pharmacology, University of California, Davis (B.H., J.M.H., E.Y.S., N.R.H., J.B., D.M.B.).,Research Group in Veterinary Medicine (GIVET), School of Veterinary Medicine, University Corporation Lasallista (Unilasallista), Caldas, Antioquia, Colombia (J.M.H.)
| | - Erin Y Shen
- Department of Pharmacology, University of California, Davis (B.H., J.M.H., E.Y.S., N.R.H., J.B., D.M.B.)
| | - Nima R Habibi
- Department of Pharmacology, University of California, Davis (B.H., J.M.H., E.Y.S., N.R.H., J.B., D.M.B.)
| | - Julie Bossuyt
- Department of Pharmacology, University of California, Davis (B.H., J.M.H., E.Y.S., N.R.H., J.B., D.M.B.)
| | - Donald M Bers
- Department of Pharmacology, University of California, Davis (B.H., J.M.H., E.Y.S., N.R.H., J.B., D.M.B.)
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50
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Attachaipanich T, Chattipakorn SC, Chattipakorn N. Potential roles of sodium-glucose co-transporter 2 inhibitors in attenuating cardiac arrhythmias in diabetes and heart failure. J Cell Physiol 2022; 237:2404-2419. [PMID: 35324001 DOI: 10.1002/jcp.30727] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/02/2022] [Accepted: 03/12/2022] [Indexed: 12/12/2022]
Abstract
Sodium-glucose co-transporter 2 (SGLT-2) inhibitors are antidiabetic drugs that have been shown to exert cardiovascular benefits. Their benefits including a reduction of cardiovascular events and worsening heart failure have been extended to nondiabetic patients with high-risk. Although both heart failure and diabetes are known to increase risk of cardiac arrhythmias, the effects of SGLT-2 inhibitors on arrhythmia reduction and their underlying mechanisms are still not fully understood. This review aims to summarize the current available evidence ranging from basic research to clinical reports regarding the potential benefits of SGLT-2 inhibitors against cardiac arrhythmias. Previous in vitro and in vivo studies using various models including heart failure and diabetes are comprehensively summarized to examine the evidence of how SGLT-2 inhibitors affect cardiac action potential, cellular ion currents, calcium ion homeostasis, and cardiac mitochondrial function. Clinical reports investigating the association between SGLT-2 inhibitors and arrhythmias including atrial fibrillation and ventricular arrhythmias are also comprehensively summarized. Valuable information obtained from this review can be used to encourage further clinical investigations to warrant the potential use of SGLT-2 inhibitors against cardiac arrhythmias in both diabetic and heart failure settings.
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Affiliation(s)
- Tanawat Attachaipanich
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Siriporn C Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand.,Cardiac Electrophysiology Research Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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