Empagliflozin, an SGLT2 inhibitor, showed positive results for heart failure with preserved ejection fraction according to Boehringer's statement.♥️
Full results will be released in August.
Let's discuss SGLT2 inhibitors?
boehringer-ingelheim.us/press-release/…
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#MedEd #FOAMed
Full results will be released in August.
Let's discuss SGLT2 inhibitors?
boehringer-ingelheim.us/press-release/…
Follow the 🧵
#MedEd #FOAMed
Sodium-glucose transport proteins (SGLT) are found both in the small intestines (SGLT1) and in the kidneys (SGLT2).
In the nephron, SGLT2 is the main responsible for the reabsorption of the filtered glucose. For this reason, its inhibition⬆️ glucosuria, decreasing hyperglycemia.
In the nephron, SGLT2 is the main responsible for the reabsorption of the filtered glucose. For this reason, its inhibition⬆️ glucosuria, decreasing hyperglycemia.
Phlorizin, a non-selective SGLT inhibitor, was isolated in the 1800s.
Why don't we use it?
- Instability;
- ⬇️ bioavailability;
- Inhibition of SGLT1, leading to ⬇️ intestinal glucose absorption and diarrhea
Why don't we use it?
- Instability;
- ⬇️ bioavailability;
- Inhibition of SGLT1, leading to ⬇️ intestinal glucose absorption and diarrhea
In 2013, the first SGLT2 inhibitor (SGLT2i), canagliflozin was eventually approved for diabetes treatment.
In 2014, empagliflozin and dapagliflozin were approved.
Ok, let's use it to treat diabetes, but, in 2008, FDA changed the rules for diabetes drugs.
In 2014, empagliflozin and dapagliflozin were approved.
Ok, let's use it to treat diabetes, but, in 2008, FDA changed the rules for diabetes drugs.
Since 2008 all new diabetes drugs should comply with the guidance below after phase 3
"Guidance for Industry on Diabetes Mellitus—Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes"
govinfo.gov/content/pkg/FR…
"Guidance for Industry on Diabetes Mellitus—Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes"
govinfo.gov/content/pkg/FR…
What does it mean?
SGLT2i manufacturers had to sponsor non-inferiority clinical trials to prove cardiovascular safety.
These trials often use the primary combined outcome of stroke, MI, CV death, and hospitalizations due to HF.
SGLT2i manufacturers had to sponsor non-inferiority clinical trials to prove cardiovascular safety.
These trials often use the primary combined outcome of stroke, MI, CV death, and hospitalizations due to HF.
EMPA-REG was the first trial after 2008 FDA guidance to be converted from noninferiority to superiority as it showed more than safety, it showed benefits!
What a landmark!
-->35% reduction in HF hospital admissions.
nejm.org/doi/full/10.10…
What a landmark!
-->35% reduction in HF hospital admissions.
nejm.org/doi/full/10.10…
If it worked for patients with diabetes and HF, what about using it to treat HFrEF regardless of diabetes?
It worked! Another landmark study!
In 2019 HFrEF treatment gained another ally!
nejm.org/doi/full/10.10…
It worked! Another landmark study!
In 2019 HFrEF treatment gained another ally!
nejm.org/doi/full/10.10…
It is not a surprise, but great news, to know that soon we will see data confirming SGLT2i to cut the risk of hospitalization and cardiovascular death for patients with HFpEF.
This is not the 1st time that a drug developed to treat diabetes effectively treat other diseases.
GLP-1 receptor agonists are a great treatment for obesity, but this is another story...
GLP-1 receptor agonists are a great treatment for obesity, but this is another story...
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