SGLT2 Inhibitor Outcomes Vary When Stratified By Patient Race | ASHP Midyear

There is a substantial initial decrease in overall survival within the first year after initiating sodium-glucose cotransporter 2 (SGLT2) inhibitor therapy in some patients with heart failure with preserved ejection fraction (HFpEF), according to research results presented at the American Society of Health-System Pharmacists 2024 Midyear Clinical Meeting and Exhibition, held December 8 to 12, 2024, in New Orleans, Louisiana.¹

Efficacy data for dapagliflozin and empagliflozin in a group of Asian patients were evaluated. | Image credit: blacksalmon - stock.adobe.com

Although results of the EMPEROR-Preserved and DELIVER clinical trials showed that both dapagliflozin (Farxiga) and empagliflozin (Jardiance) can improve cardiovascular outcomes in HFpEF, both trials found differences in primary outcomes among Asian individuals when stratified by race and ethnicity.

Therefore, researchers analyzed data from a cohort of patients at Princess Margaret Hospital in Hong Kong, collected between 2016 and 2022, to further understand these differences.

The primary composite outcome of the analysis was combined cardiovascular death and hospitalization due to heart failure; adverse effects were also evaluated and reported as safety outcomes.

READ MORE: Real-Time Pharmacist Feedback Improves Heart Failure Medication Management 

Data from a total of 85 adults were reviewed (dapagliflozin n=26, empagliflozin n=59). Investigators found that both cardiovascular and mortality outcomes were higher than noted in previous literature: Dapagliflozin use was associated with 29.9 composite outcome events per 100 patient-years, while empagliflozin use was associated with 24.9 events per 100 person-years. Patients taking empagliflozin who did not have heart failure hospitalization in the prior 12 months experienced “significantly better composite outcomes” compared with patients taking dapagliflozin (HR, 0.30; 95% CI, 0.12-0.76). Despite this, no significant differences were noted in composite outcome and all-cause mortality between the groups.

Study limitations include the small sample size.

“A substantial initial decrease in overall survival toward the primary composite outcome within the first year after the start of SGLT-2 inhibitor administration indicates the need for early intervention for this specific patient subgroup,” the researchers concluded. “The findings of this study highlight the importance of conducting additional research to explore the comparative efficacy of SGLT-2 inhibitors for HFpEF in a larger local population.”

READ MORE: Cardiology Resource Center

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Reference

1. Tam WJ, Cheng WTF, So IYA, Ng V. Mortality and hospitalization rate of heart failure patients with preserved ejection fraction treated with dapagliflozin vs empagliflozin. Presented at: American Society of Health-System Pharmacists 2024 Midyear Clinical Meeting and Exhibition; December 8-12, 2024; New Orleans, LA. Poster 8-045.