SGLT2 inhibition may improve CV outcomes in those with diabetes undergoing cancer therapy
In patients with diabetes and cancer treated with anthracyclines, SGLT2 inhibition was associated with fewer cardiac events during 1.5 years of follow-up, researchers reported.
According to data published in JACC: Heart Failure, patients with cancer and diabetes taking SGLT2 inhibitors also experienced lower mortality, sepsis and neutropenic fever compared with controls not treated with an SGLT2 inhibitor.
“The use of anthracyclines as a standard cancer therapy is limited by the potential for the development of cardiac dysfunction. ... Although there are no clinical studies reporting the effect of SGLT2 inhibitors on cardiac events among patients treated with anthracycline, there are supportive basic science data,” Carlos A. Gongora, MD, clinical fellow in radiology in the Cardiovascular Imaging Research Center at Massachusetts General Hospital, and colleagues wrote. “We hypothesized that SGLT2 inhibitors would be associated with improved cardiac outcomes in patients treated with anthracyclines.”
To test this hypothesis, researchers identified 32 patients with cancer treated with anthracyclines who simultaneously received an SGLT2 inhibitor for treatment of diabetes. The researchers also analyzed a control group of 96 similar patients who were not on an SGLT2 inhibitor. The primary outcome was a composite of cardiac events, including HF incidence, HF admissions, new cardiomyopathy and clinically significant arrhythmias, during a median follow-up of 1.5 years. The primary safety outcome was overall mortality.
Baseline characteristics between the groups were similar and the overall mean age was 60 years, with about half being women.
Prevalence of CV risk factors was also similar between groups.
The most common SGLT2 inhibitor was empagliflozin (50%; Jardiance, Boehringer Ingelheim/Eli Lilly), followed by canagliflozin (34%; Invokana, Janssen) and dapagliflozin (16%; Farxiga, AstraZeneca).
The most common anthracycline used was doxorubicin, and there was no difference in the cumulative dosing of doxorubicin between the SGLT2 inhibitor-treated group and the control group (P = .7).
Twenty cardiac events occurred during the follow-up period.
Cardiac events occurred in 3% of the SGLT2 inhibitor-treated arm compared with 20% of control participants (P = .025).
Moreover, patients treated with SGLT2 inhibitors experienced lower overall mortality (9% vs. 43%; P < .001) and a lower composite of sepsis and neutropenic fever (16% vs. 40%; P = .013) compared with patients in the control arm.
“To our knowledge, these findings are the first data associating SGLT2 inhibitors with improved cardiac and noncardiac outcomes in this population,” the researchers wrote. “These findings support conducting randomized trials testing the effect of SGLT2 inhibitors on cardiac outcomes in patients treated with anthracyclines.”
Collapse