Study: New Diabetes Drug Class Reduces Heart Deaths

April 7, 2017

New class of glucose-lowering agents lowers hospitalization and death rates even in Type 2 patients without heart disease.

Treatment with the SGLT-2i class of glucose-lowering drugs reduced the rate of hospitalization for heart failure by 39% and for death from any cause by 51% in type 2 diabetes (T2D) patients, according to a new study.

The first large real-world evidence study of its kind, was presented by AstraZeneca at the American College of Cardiology 66th Annual Scientific Sessions in Washington, DC. The CVD-REAL study reviewed the effects of three SGLT-2i drugs-dapagliflozin (Farxiga), canagliflozin, and empagliflozin-on heart failure and death rates.

The study evaluated more than 300,000 patients with T2D in six countries, of whom 87% did not have a history of cardiovascular disease. Nearly 42% of these patients took Farxiga, 52.7% took canagliflozin, and 5.5% took empagliflozin. The analysis of death from any cause was conducted using anonymized patient data from Denmark, Norway, Sweden, the United Kingdom, and the United States.

“The data from this real-world study demonstrated that treatment with the SGLT-2i class of medicines cut the rate of hospitalizations for heart failure and death by approximately half compared to other standard approved diabetes treatments,” said Steven Zelenkofske, DO, AstraZeneca’s Vice President for Medical Affairs, Cardiovascular and Metabolic Disease in the United States, told Drug Topics.

Mikhail Kosiborod, MDTreatment with SGLT-2i glucose-lowering drugs was associated with “dramatic, and highly significant reductions in hospitalizations for heart failure and all-cause mortality,” Mikhail Kosiborod, MD, Director of the Cardiometabolic Research Group at Saint Luke’s Mid America Heart Institute, told Drug Topics.

“These compelling results were consistent across all countries included in the study, despite the fact that different SGLT-2i compounds were predominantly used in Europe versus the U.S., suggesting a class effect,” Kosiborod said. “Furthermore, our results suggest that these observed benefits may extend to lower-risk patients with type 2 diabetes, since 87% of patients in our study did not have established cardiovascular disease.”

SGLT-2i is the first class of glucose-lowering agents that appears to significantly reduce the risk of developing heart failure in patients with T2D, Kosiborod said. “Until now, there were no glucose-lowering medications found to be beneficial in reducing heart failure hospitalizations in this patient group. Certain classes of glucose-lowering agents were previously found to increase the risk of heart failure, while others appear to be neutral in this regard, or had no definitive data from clinical trials.”

As a result, SGLT-2i drugs should be prioritized in the management of patients with T2D, according to Kosiborod.

 This is the first of several comparative analyses of CVD-REAL. “The study is ongoing and future analyses will be conducted using this data set, as well as data from other countries. This will help better understand the effects of SGLT-2i on various patient outcomes,” Kosiborod said. “We are also awaiting the results of ongoing randomized controlled trials of various SGLT-2i compounds, as well as smaller studies that are looking into the mechanisms that may explain the benefits that we observed in CVD-REAL study.”