Dapagliflozin Effective Regardless of Background Diabetes Therapies

New research from an analysis of the historic DAPA-HF trial indicates the benefits of dapagliflozin (Farxiga) use were not mitigated by background diabetic therapies.

Presented at the American Diabetes Association’s (ADA) 80th Scientific Sessions, results of the analysis indicate dapagliflozin improved clinical outcomes in the trials diabetic population, which represented nearly half of the trial’s total population, regardless of the presence or type of glucose-lowering medication patients were using at the time.

“Ultimately, the benefit of dapagliflozin was not modified by use of background therapy,” said study presenter Kieran Docherty, MBChB, a clinical research fellow in the Institute of Cardiovascular and Medical Sciences at the University of Glasgow, in an interview with HCPLive®. “So both in patients that were on another glucose-lowering medication or patients who were not on any glucose-lowering agents, dapagliflozin was as effective in both groups.”

With excitement continuing to grow around the SGLT2 inhibitor class and dapagliflozin responsible for much of the ongoing excitement, the most recent analysis presented at ADA 2020 adds to speculation behind the underlying mechanism, which allows the class to provide such an array of benefits. Of the original 4744 patients included in DAPA-HF, 2139 were considered type 2 diabetics.

At baseline, 75% of the diabetic patients were on a glucose-lowering medication. The most common of these were metformin (48%) followed by insulin (25%), sulfonylureas (21%), DDP-4 inhibitors (14%), and GLP-1 agonists (1%). Of note, drug-naive patients had a lower HbA1c (6.9%±1.2 vs 7.5%±1.6; P <.001) and shorter duration of diabetes (median 5.5 vs 103 months; P <.001) than those on glucose-lowering medications. Additionally, those not using metformin had a lower EGFR than those using metformin (61 vs 66; P <.001).

Results of the analysis revealed the effect of dapagliflozin on the primary outcome, which was a composite of worsening heart failure and cardiovascular death, was consistent regardless of whether patients were drug-naive or receiving glucose-lowering medication (HR, 0.86; 95% CI, 0.60-1.23 vs. HR, 0.72; 95% CI, 0.58-0.88; P-interaction=.39). Investigators also highlighted the effect of dapagliflozin was also consistent irrespective of the use of metformin (HR 0.67; 95% CI, 0.51-0.88 vs HR, 0.81; 95% CI, 0.64-1.03; P-interaction=.30).

To learn more about the results of his study, HCPLive invited Docherty to take part in a special edition ADA 2020 House Call.

This study, “Does Background T2D Therapy Modify the Benefits of Dapagliflozin in Heart Failure? Analysis of the DAPA-HF Trial,” was presented at ADA 2020.