TY - JOUR
T1 - Sodium–glucose co-transporter 2 inhibitors as an early, first-line therapy in patients with heart failure and reduced ejection fraction
AU - Tomasoni, Daniela
AU - Fonarow, Gregg C.
AU - Adamo, Marianna
AU - Anker, Stefan D.
AU - Butler, Javed
AU - Coats, Andrew J.S.
AU - Filippatos, Gerasimos
AU - Greene, Stephen J.
AU - McDonagh, Theresa A.
AU - Ponikowski, Piotr
AU - Rosano, Giuseppe
AU - Seferovic, Petar
AU - Vaduganathan, Muthiah
AU - Voors, Adriaan A.
AU - Metra, Marco
N1 - Funding Information:
: G.C.F. reports consulting for Abbott, Amgen, AstraZeneca, Bayer, Cytokinetics, Janssen, Edwards, Medtronic, Merck, and Novartis. M.A. reports speaker fees from Abbott Vascular and Medtronic. S.D.A. reports receiving fees from Abbott, Actimed, Bayer, Boehringer Ingelheim, Cardiac Dimension, Cordio, Impulse Dynamics, Novartis, Occlutech, Servier, and Vifor Pharma, and grant support from Abbott and Vifor Pharma. J.B. reports consults to Astra Zeneca, Array, Amgen, Boehringer Ingelheim, CVRx, G3 Pharma, Impulse Dynamics, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, NovoNordisk, Relypsa, Roche, Sequana, V‐Wave Ltd., and Vifor. A.J.S.C. declares consultancy fees from Astra Zeneca, Boehringer Ingelheim, Menarini, Novartis, Servier, Vifor, Abbott, Actimed, Arena, Cardiac Dimensions, Corvia, CVRx, Enopace, ESN Cleer, Faraday, Impulse Dynamics, Respicardia, Viatris. G.F. reports personal fees from Medtronic, Vifor, Servier, Novartis, Bayer, Amgen, and Boehringer Ingelheim, outside the submitted work. S.J.G. has received research support from the Duke University Department of Medicine Chair's Research Award, American Heart Association, Amgen, AstraZeneca, Bristol Myers Squibb, Cytokinetics, Merck, Novartis, Pfizer, and Sanofi; has served on advisory boards for Amgen, AstraZeneca, Bristol Myers Squibb, and Cytokinetics; and serves as a consultant for Amgen, Bayer, Bristol Myers Squibb, Merck, and Vifor. T.A.M. has received honoraria from Vifor Pharma, Astra Zeneca, Novartis and Boheringer Ingelheim. P.S. declares consulting fees from Boehringer Ingelheim and Novartis and Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Astra Zeneca, Boehringer Ingelheim, Novartis. M.V. has received research grant support or served on advisory boards for American Regent, Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, Boehringer Ingelheim, Cytokinetics, Lexicon Pharmaceuticals, Novartis, Pharmacosmos, Relypsa, Roche Diagnostics, and Sanofi, speaker engagements with Novartis and Roche Diagnostics, and participates on clinical endpoint committees for studies sponsored by Galmed and Novartis. A.A.V. has received research support and/or has been a consultant for Amgen, AstraZeneca, Bayer AG, Boehringer Ingelheim, Cytokinetics, Merck, Myokardia, Novo Nordisk, Novartis, and Roche Diagnostics. M.M. reports fees from Actelion, Amgen, Astra‐Zeneca, Livanova, Servier, Vifor pharma and WindTree Therapeutics as member of clinical trials committees or advisory boards and from Abbott vascular, Bayer, Boheringer Ingelhelm and Edwards Therapeutics for speeches at sponsored meetings in the last three years. Conflict of interest
Funding Information:
Open Access Funding provided by Universita degli Studi di Brescia within the CRUI-CARE Agreement.Conflict of interest: G.C.F. reports consulting for Abbott, Amgen, AstraZeneca, Bayer, Cytokinetics, Janssen, Edwards, Medtronic, Merck, and Novartis. M.A. reports speaker fees from Abbott Vascular and Medtronic. S.D.A. reports receiving fees from Abbott, Actimed, Bayer, Boehringer Ingelheim, Cardiac Dimension, Cordio, Impulse Dynamics, Novartis, Occlutech, Servier, and Vifor Pharma, and grant support from Abbott and Vifor Pharma. J.B. reports consults to Astra Zeneca, Array, Amgen, Boehringer Ingelheim, CVRx, G3 Pharma, Impulse Dynamics, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, NovoNordisk, Relypsa, Roche, Sequana, V-Wave Ltd., and Vifor. A.J.S.C. declares consultancy fees from Astra Zeneca, Boehringer Ingelheim, Menarini, Novartis, Servier, Vifor, Abbott, Actimed, Arena, Cardiac Dimensions, Corvia, CVRx, Enopace, ESN Cleer, Faraday, Impulse Dynamics, Respicardia, Viatris. G.F. reports personal fees from Medtronic, Vifor, Servier, Novartis, Bayer, Amgen, and Boehringer Ingelheim, outside the submitted work. S.J.G. has received research support from the Duke University Department of Medicine Chair's Research Award, American Heart Association, Amgen, AstraZeneca, Bristol Myers Squibb, Cytokinetics, Merck, Novartis, Pfizer, and Sanofi; has served on advisory boards for Amgen, AstraZeneca, Bristol Myers Squibb, and Cytokinetics; and serves as a consultant for Amgen, Bayer, Bristol Myers Squibb, Merck, and Vifor. T.A.M. has received honoraria from Vifor Pharma, Astra Zeneca, Novartis and Boheringer Ingelheim. P.S. declares consulting fees from Boehringer Ingelheim and Novartis and Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Astra Zeneca, Boehringer Ingelheim, Novartis. M.V. has received research grant support or served on advisory boards for American Regent, Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, Boehringer Ingelheim, Cytokinetics, Lexicon Pharmaceuticals, Novartis, Pharmacosmos, Relypsa, Roche Diagnostics, and Sanofi, speaker engagements with Novartis and Roche Diagnostics, and participates on clinical endpoint committees for studies sponsored by Galmed and Novartis. A.A.V. has received research support and/or has been a consultant for Amgen, AstraZeneca, Bayer AG, Boehringer Ingelheim, Cytokinetics, Merck, Myokardia, Novo Nordisk, Novartis, and Roche Diagnostics. M.M. reports fees from Actelion, Amgen, Astra-Zeneca, Livanova, Servier, Vifor pharma and WindTree Therapeutics as member of clinical trials committees or advisory boards and from Abbott vascular, Bayer, Boheringer Ingelhelm and Edwards Therapeutics for speeches at sponsored meetings in the last three years.
Publisher Copyright:
© 2021 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2022/3
Y1 - 2022/3
N2 - Sodium–glucose co-transporter 2 (SGLT2) inhibitors have recently been recommended as a foundational therapy for patients with heart failure (HF) and reduced ejection fraction (HFrEF) because of their favourable effects on mortality, clinical events and quality of life. While clinical practice guidelines have recommended dapagliflozin or empagliflozin in all patients with HFrEF, or sotagliflozin in those with HFrEF and concomitant diabetes, the timing and practical integration of these drugs in clinical practice is less well defined. We propose that these drugs are candidates for early, upfront administration to patients with newly diagnosed HFrEF and for patients hospitalized with HF. Growing evidence has established early benefits, with clinically meaningful reductions in clinical events that reach statistical significance within days to weeks, following dapagliflozin, empagliflozin or, in diabetic patients, sotagliflozin initiation. Secondly, although major clinical trials have tested these drugs in patients already receiving background HF therapy, secondary analyses showed that their efficacy is independent of that. Third, SGLT2 inhibitors are generally safe and well tolerated, with clinical trial data reporting minimal effects on blood pressure, glycaemia-related adverse events, and no excess in acute kidney injury. Rather, they exert renal protective effects and reduce risk of hyperkalaemia, properties that favour initiation, tolerance and persistence of renin–angiotensin system inhibitors and mineralocorticoid receptor antagonists. This review supports the early initiation of dapagliflozin and empagliflozin (or sotagliflozin limited to patients with diabetes) to rapidly improve clinical outcome and quality of life of HFrEF patients.
AB - Sodium–glucose co-transporter 2 (SGLT2) inhibitors have recently been recommended as a foundational therapy for patients with heart failure (HF) and reduced ejection fraction (HFrEF) because of their favourable effects on mortality, clinical events and quality of life. While clinical practice guidelines have recommended dapagliflozin or empagliflozin in all patients with HFrEF, or sotagliflozin in those with HFrEF and concomitant diabetes, the timing and practical integration of these drugs in clinical practice is less well defined. We propose that these drugs are candidates for early, upfront administration to patients with newly diagnosed HFrEF and for patients hospitalized with HF. Growing evidence has established early benefits, with clinically meaningful reductions in clinical events that reach statistical significance within days to weeks, following dapagliflozin, empagliflozin or, in diabetic patients, sotagliflozin initiation. Secondly, although major clinical trials have tested these drugs in patients already receiving background HF therapy, secondary analyses showed that their efficacy is independent of that. Third, SGLT2 inhibitors are generally safe and well tolerated, with clinical trial data reporting minimal effects on blood pressure, glycaemia-related adverse events, and no excess in acute kidney injury. Rather, they exert renal protective effects and reduce risk of hyperkalaemia, properties that favour initiation, tolerance and persistence of renin–angiotensin system inhibitors and mineralocorticoid receptor antagonists. This review supports the early initiation of dapagliflozin and empagliflozin (or sotagliflozin limited to patients with diabetes) to rapidly improve clinical outcome and quality of life of HFrEF patients.
UR - http://www.scopus.com/inward/record.url?scp=85122722699&partnerID=8YFLogxK
U2 - 10.1002/ejhf.2397
DO - 10.1002/ejhf.2397
M3 - Article
C2 - 34894038
AN - SCOPUS:85122722699
SN - 1388-9842
VL - 24
SP - 431
EP - 441
JO - EUROPEAN JOURNAL OF HEART FAILURE
JF - EUROPEAN JOURNAL OF HEART FAILURE
IS - 3
ER -