Dapagliflozin performs consistently across LVEF in HF

Dapagliflozin was associated with improved symptoms and physical limitations of patients with heart failure (HF) across the entire range of left ventricular ejection fractions (LVEFs). With this finding, the current, pooled analysis of the DEFINE-HF and PRESERVED-HF trials supports the use of dapagliflozin in patients with HF, irrespective of LVEF.

“Whether sodium-glucose cotransporter-2 (SGLT2) inhibitors consistently improve the symptoms and physical limitations across the entire range of LVEF in patients with HF is not well established,” explained Dr Mikhail Kosiborod (St. Luke’s Hospital, MO, USA) [1]. Therefore, a pooled analysis of the DEFINE-HF trial (NCT02653482), including 263 patients with LVEF ≤40%, and the PRESERVED-HF trial (NCT03030235), including 324 patients with LVEF ≥45%, was conducted to assess this matter [2,3]. In both trials, the Kansas City Cardiomyopathy Questionnaire (KCCQ) clinical summary score (CSS) at week 12 was the primary endpoint.

After 12 weeks, patients on dapagliflozin displayed an improvement of 5.0 points on the KCCQ-CSS compared with placebo (P<0.0001). Importantly, this result was consistent across LVEF subgroups (P_interaction=0.79). The corresponding mean changes in KCCQ-CSS score were 4.57, 4.91, and 6.77 for patients with LVEF ≤40%, >40% to <60%, and ≥60%, respectively. This result was consistent when it was measured on a continuous scale (see Figure). Similar consistent results were obtained for other KCCQ domains.

“These results support the use of dapagliflozin in patients with HF, regardless of EF,” concluded Dr Kosiborod.

Figure: Effect of dapagliflozin versus placebo on KCCQ-CSS across LVEF [1]



LVEF, left ventricular ejection fraction.

1. Kosiborod M, et al. DEFINE-HF and PRESERVED-HF: Dapagliflozin improves heart failure symptoms and physical limitations across the entire range of LVEF. LBT Pharmacological treatment I, Heart Failure 2022, 21–24 May, Madrid, Spain.
2. Nassif ME, et al. Circulation 2019;140(18):1463–1476.
3. Nassif ME, et al. Nat Med 2021;27(11):1954–1960.

 

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Posted on 28 July, 2022