December 2022

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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Finerenone efficacy in patients with chronic kidney disease, type 2 diabetes and atherosclerotic cardiovascular disease

Eur Heart J Cardiovasc Pharmacother. 2022; online ahead of print DOI: 10.1093/ehjcvp/pvac054

Finerenone reduced the risk of CV and kidney outcomes consistently across the spectrum of CKD in patients with T2D, irrespective of prevalent ASCVD.

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Effect of Dapagliflozin on Cause-Specific Mortality in Patients With Heart Failure Across the Spectrum of Ejection Fraction: A Participant-Level Pooled Analysis of DAPA-HF and DELIVER

JAMA Cardiol. 2022; online ahead of print DOI: 10.1001/jamacardio.2022.3736

In a prospective, patient-level pooled meta-analysis of the DAPA-HF and DELIVER trials, dapagliflozin-associated reductions in CV mortality in patients with HF appeared to be principally due to lower rates of sudden death and HF death, regardless of EF.

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Empagliflozin and Left Ventricular Remodeling in People Without Diabetes: Primary Results of the EMPA-HEART 2 CardioLink-7 Randomized Clinical Trial

Circulation. 2022; online ahead of print DOI: 10.1161/CIRCULATIONAHA.122.062769

Among patients with neither diabetes nor significant HF but with risk factors for adverse cardiac remodelling, empagliflozin did not result in a meaningful reduction in change in left ventricular mass indexed (LVMi) to baseline body surface area (BSA) after 6 months as measured by cardiac magnetic resonance imaging.

SGLT2i have demonstrated reverse cardiac remodelling in patients with diabetes or HF, but their effects earlier in the natural history of HF are less well studied.

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October 2022

Network meta-analysis of mineralocorticoid receptor antagonists for diabetic kidney disease

Front Pharmacol. 2022;13:967317 DOI: 10.3389/fphar.2022.967317

A network meta-analysis has found that newer mineralocorticoid receptor antagonists (MRAs) appear to have greater efficacy in reducing urine albumin creatinine ratio (UACR) vs baseline than traditional MRAs in the treatment of diabetic kidney disease (DKD).

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