January 2023

Effect of Finerenone on Ambulatory Blood Pressure in Chronic Kidney Disease in Type 2 Diabetes

J Hypertens. 2023;41:295–302 DOI: 10.1097/HJH.0000000000003330

It has been postulated that the effects of finerenone on cardiorenal outcomes may be mediated primarily via non-haemodynamic pathways, but office BP measurements are insufficient to fully assess haemodynamic effects. A substudy of the ARTS-DN phase IIb trial was conducted to obtain further insights into the mechanism of action of finerenone by analysing 24-h ambulatory BP in patients with CKD and T2D.

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Efficacy of Empagliflozin in Heart Failure with Preserved versus Mid-range Ejection Fraction: a Pre-specified Analysis of EMPEROR-Preserved

Nat Med. 2022;28:2512–2520 DOI: 10.1038/s41591-022-02041-5

Results from EMPEROR-Preserved demonstrated that empagliflozin improved CV death and HF hospitalisation – the primary outcome – in patients with HF and LVEF >40%. This pre-specified analysis of EMPEROR-Preserved aimed to evaluate the effect of empagliflozin in patients with HFpEF (LVEF ≥50%) compared with patients who had HFmrEF (LVEF 41–49%).

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Empagliflozin, Irrespective of Blood Pressure, Improves Outcomes in Heart Failure with Preserved Ejection Fraction: the EMPEROR-Preserved Trial

Eur Heart J. 2022; online ahead of print DOI: 10.1093/eurheartj/ehac693

Results from EMPEROR-Preserved demonstrated that empagliflozin improved CV and renal outcomes in patients with HFpEF, but its efficacy and safety with baseline SBP is not well established.

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December 2022

Empagliflozin in Black Versus White Patients with Heart Failure: Analysis of EMPEROR-Pooled

Circulation. 2022; online ahead of print DOI: 10.1161/CIRCULATIONAHA.122.062644

While analyses from DAPA-HF and EMPEROR-Reduced demonstrated a consistent benefit of SGLT2i in Black patients, data were limited to HFrEF and included a small number of Black patients. In the current analysis, the efficacy and safety of empagliflozin according to Black vs White race in the Americas was assessed across the spectrum of EF in EMPEROR-Pooled, a combined dataset from both EMPEROR trials.

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Efficacy and Safety of Dapagliflozin by Baseline Insulin Regimen and Dose: Post Hoc Analyses From DECLARE-TIMI 58

Diabetes Care. 2022; online ahead of print DOI: 10.2337/dc22-1318

Limited data exist regarding the cardiorenal efficacy and safety of SGLT2i in patients treated with intensive insulin regimens including short-acting insulin or high insulin doses. This post hoc analysis of DECLARE-TIMI 58 examined the effects of dapagliflozin vs placebo among 7,013 insulin users at baseline, of whom 4,650 were on regimens that included short-acting insulin and 1,339 were receiving insulin >1 IU/kg.

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Efficacy and Safety of Dapagliflozin in Patients with Heart Failure with Mildly Reduced or Preserved Ejection Fraction by Baseline Glycaemic Status (DELIVER): a Subgroup Analysis from an International, Multicentre, Double-blind, Randomised, Placebo-controlled Trial

Lancet Diabetes Endocrinol. 2022;10:869–881 DOI: 10.1016/S2213-8587(22)00308-4

Dapagliflozin was shown to be highly efficacious in patients with HFmrEF and HFpEF in the DELIVER trial. However, whether the benefits of dapagliflozin are observed across glycaemia categories has not been previously reported.

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Effects of Empagliflozin on Cardiovascular and Renal Outcomes in Heart Failure with Reduced Ejection Fraction According to Age: a Secondary Analysis of EMPEROR-Reduced

Eur J Heart Fail. 2022; online ahead of print DOI: 10.1002/ejhf.2707

Results from EMPEROR-Reduced demonstrated that empagliflozin improved CV and renal outcomes in patients with HFrEF, but its efficacy and safety across patient's age is not well established.

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November 2022

Empagliflozin in Patients with Chronic Kidney Disease

N Engl J Med. 2022; online ahead of print

Among a wide range of at-risk patients with CKD, empagliflozin reduced progression of kidney disease or death from CV causes compared with placebo in the EMPA-KIDNEY trial.

Previous large trials involving patients with diabetic kidney disease and albuminuria have shown that SGLT2i reduce the risk of progression to kidney failure; however, most patients with CKD have low levels of albuminuria (UACR <300 mg/g) and do not have diabetes.

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Time to Clinical Benefit of Dapagliflozin in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction: A Prespecified Secondary Analysis of the DELIVER Randomized Clinical Trial

JAMA Cardiol. 2022; online ahead of print DOI: 10.1001/jamacardio.2022.3750

Dapagliflozin was recently shown to reduce CV death or worsening HF events in patients with HF with mildly reduced or preserved ejection fraction in the DELIVER trial. This prespecified secondary analysis of DELIVER examined the timeline to onset of clinical benefit with dapagliflozin.

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Cost-Effectiveness of Dapagliflozin as a Treatment for Chronic Kidney Disease: A Health-Economic Analysis of DAPA-CKD

Clin J Am Soc Nephrol. 2022; online ahead of print DOI: 10.2215/CJN.03790322

Dapagliflozin has been shown to reduce CKD progression and KRT requirement when added to standard therapy in patients with CKD in the DAPA-CKD trial. This analysis was designed to estimate the cost-effectiveness of dapagliflozin for the treatment of CKD from payer perspectives in the UK, Germany and Spain.

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