Real-world evidence has shown that treatment with the newer SGLT2 inhibitor class of diabetes drug can dramatically cut heart failure and death rates, says AstraZeneca.
The CVD-REAL study – presented at the American College of Cardiology (ACC) meeting in Washington DC – examined patient records from 300,000 people across six countries and found that treatment with SGLT2 inhibitors cut hospitalisations for heart failure by 39% and all-cause mortality by 51% compared to matched patients on other glucose-lowering therapies.
Crucially, the majority (87%) of the diabetes patient registry did not have a history of cardiovascular disease, suggesting that the drugs may have an impact on the development of cardiovascular complications such as heart failure in type 2 diabetics.
Similar findings were reported in the prospective, randomised EMPA-REG OUTCOME trial in 2015, which showed that Eli Lilly and Boehringer Ingelheim’s Jardiance (empagliflozin) was able to achieve a 35% reduction in hospitalisations for heart failure in a high-risk patient group.
Now, AZ’s study suggests that benefit is reproduced in a generalised, real-world setting and that other SGLT2 inhibitors – including its own Forxiga/Farxiga (dapagliflozin) and Johnson & Johnson’s Invokana (canagliflozin) – provide a similar benefit.
Around 42% of patients in CVD-REAL were on Forxiga, with almost 53% on Invokana and 5% on Jardiance, with use of AZ’s drug more common in Europe and J&J’s drug dominant in the US. The similar outcome regardless of the individual drug and region also points to a class effect.
Mikhail Kosiborod of the University of Missouri-Kansas City School of Medicine, who presented the results at the ACC meeting, said the data suggests that the benefit can also extend to patients with type 2 diabetes at the lower end of the cardiovascular risk spectrum.
As it stands only Jardiance has the benefit of the cardiovascular risk reduction on its label, but the new findings could help encourage prescribing of SGLT2 inhibitors as a whole over other classes such as DPP4 inhibitors. “This class has a real potential of improving patient outcomes,” said Kosiborod.
In the meantime, AZ is conducting its own large-scale clinical trials to determine the effect of Farxiga on cardiovascular risk, with results expected in 2019.
J&J’s Invokana and line extensions brought in $1.4bn in sales last year, largely flat on the prior year, while AZ reported Forxiga sales of $832m (up 72%) and Jardiance rose 60% to $202m. The three main competitors could soon be joined by Merck & Co and Pfizer’s recently-filed ertugliflozin.