AHA: Change the rules of the game! Dapagliflozin has greater benefits for non-diabetic patients with heart failure

This year, dagrinine's "new impression" is that, with or without type 2 diabetes, it can reduce the risk of cardiovascular death or deterioration of heart failure But what kind of crowd is more effective? Recently, AstraZeneca's new data has once again overturned cognition Recently, AstraZeneca announced the latest data of dapa-hf, a three-phase clinical trial of farxiga (dapagliflozin) to reduce the risk of heart failure, at the meeting of American Heart Association (AHA) held on November 16-18: compared with patients with diabetes, dapaglizin has a greater benefit on cardiovascular events in patients with non diabetic heart failure According to the analysis of more subgroup data published at the AHA meeting on the 16th, in terms of cardiovascular event death and hospitalization risk of heart failure, dagglitazine (10mg once a day) can reduce the risk of heart failure patients with diabetes by 25% and that of patients without diabetes by 27% compared with placebo In terms of cardiovascular death risk, dagrinine reduced the risk of heart failure in patients with and without diabetes by 21% and 15%, respectively In addition, the risk of heart failure was reduced by 23% in patients with diabetes and 38% in patients without diabetes Kiersten combs, vice president of cardiovascular and metabolic diseases at AstraZeneca in the United States, said: "the overall results of the study are groundbreaking, and the subgroup analysis data can be an example of paradigm shift science." The so-called "paradigm shift" means that new academic achievements in a certain field break the original assumptions or rules, thus forcing people to make fundamental amendments to the basic theories of the discipline Combs added: "the consistency of results across the sub population does demonstrate the quality of the data and the significance of the drug for future use in heart failure." Dapa-hf is the first randomized, double-blind, international, multicenter, phase 3 trial to study the relationship between SGLT2 inhibitors and the risk of death in heart failure In addition to the standard therapy for heart failure patients with reduced ejection fraction (LVEF ≤ 40%), dapa-hf is also the first trial to study the therapeutic effect of dagglitazine or placebo 45% of the patients were diagnosed with type 2 diabetes, while the other 55% were non diabetic The primary end point was exacerbation of heart failure (hospitalization, emergency) or cardiovascular death At the end of August this year, AstraZeneca initially released the results of dapa-hf test, which showed that dagglitazine significantly reduced the risk of cardiovascular death or heart failure deterioration by 26%; the risk of first deterioration of heart failure by 30%; the risk of death due to cardiovascular disease by 18%; and the risk of all-cause death of patients by 17% On the one hand, the study showed that dagglitazine significantly reduced HbA1c and body weight in patients with diabetes In the heart failure patients with and without diabetes mellitus, the average weight loss was 1.6kg and 0.6kg, respectively At the same time, the systolic blood pressure of the two groups also decreased On the other hand, the side effects of hypoglycemia and ketoacidosis also only occurred in the patients with diabetes; in the non diabetes patients, the incidence did not increase Based on the positive results of a number of clinical trials, dagreen seems to have embarked on the fast track of approval In August this year, the FDA granted two fast track qualifications to digrinone, namely: reducing the risk of cardiovascular death or deterioration of heart failure in adults with heart failure who have reduced or preserved ejection fraction; and delaying the deterioration of renal failure in patients with chronic kidney disease (with or without type 2 diabetes mellitus) and preventing cardiovascular and renal death In the same month, the European Union approved the forxiga label update to include prognostic data to reduce the risk of hospitalization for heart failure and cardiovascular death in patients with diabetes The update has also been submitted to China's State Drug Administration for review and a decision is expected to be made in the first half of 2020 At the end of October, the U.S Food and Drug Administration (FDA) approved farxiga to reduce the risk of hospitalization for heart failure in adults with type 2 diabetes mellitus (with cardiovascular disease or multiple cardiovascular risk factors), based on the results of the declare study The study showed that farxiga reduced the hospitalization rate of heart failure patients with diabetes mellitus and decreased ejection fraction by 36%, and that of patients without decreased ejection fraction by 24% This is the first approval of cardiovascular indications of the drug, AstraZeneca hopes to continue to attack according to dapa-hf data Dagliejing is an innovative selective inhibitor of sglt-2, which is administered orally once a day SGLT2 is a transporter in kidney to assist glucose reabsorption Its inhibitor can reduce blood glucose level by inhibiting SGLT2 function, allowing more glucose to be discharged from urine AstraZeneca believes that SGLT2 inhibitors are changing the "rules of the game" of cardiovascular and metabolic drugs Success in the cardiovascular field will help farxiga catch up with SGLT2 drugs such as Johnson & Johnson's invokana, Lilly and bringer Ingelheim's jardiance, which have updated cardiovascular benefits on their labels If farxiga can be approved for the treatment of heart failure patients with or without diabetes, the drug may become the first product of its kind to open this treatment field Reference material