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Dapagliflozin lowers all-cause mortality risk in type 2 diabetes
The risk for all-cause mortality may be lower in adults with type 2 diabetes who have been treated with the SGLT2 inhibitor dapagliflozin compared with those receiving standard treatment, according to data from a population-based, retrospective cohort study from the United Kingdom.
“The current therapies for type 2 diabetes contribute to lowering of the blood sugar but have had little impact in reducing cardiovascular events and mortality,” Wasim Hanif, PhD, professor in the diabetes department at University Hospital Birmingham, NHS Foundation, told Endocrine Today. “Recently a number of clinical trials have reported on various classes of anti-glycemic agents looking at the CV outcomes. One of the clinical trials was the EMPA-REG with empagliflozin (Jardiance, Boehringer Ingelheim and Eli Lilly), an SGLT-2 inhibitor study that showed significant reduction of CV death by 38% and all-cause mortality by 32% in patients with high risk of developing CV disease. There are other SGLT-2 inhibitors in the market including dapagliflozin (Farxiga, AstraZeneca), we examined the THIN database to see whether the EMPA-REG findings can be replicated with patients on dapagliflozn.”
Hanif and colleagues evaluated data from The Health Improvement Network Database on 22,124 adults (mean age, 58.4 years; mean BMI, 34.8 kg/m2) with type 2 diabetes (mean duration, 9 years) to determine the effect of dapagliflozin on the risk for all-cause mortality and incident CV events.
At baseline, mean HbA1c was 7.7%, 4,350 participants had a previous CVD event (ischemic heart disease, stroke and/or heart failure), and 4,444 were previously exposed to dapagliflozin.
The risk for dying from any cause was lower among participants who had been exposed to dapagliflozin compared with matched controls with diabetes under standard treatment (P = .0001); this was true even after adjustment for key covariates (P = .001).
In an evaluation of a subset of participants at low risk for CVD, participants treated with dapagliflozin had a lower risk for dying from any cause compared with controls (P = .002). However, no difference in risk was found between the two groups for the risk for incident CVD.
“This study using the THIN database established that the findings of the EMPA-REG study can be replicated in patients in dapagliflozin,” Hanif said. “The reduction in all-cause mortality are similar to EMPA-REG in the high risk population for CVD exposed to dapagliflozin. Even in patients with low risk of CVD there was significant reduction in all-cause mortality with dapagliflozin. The EMPA-REG study did not include the low-risk patients. This study indicated that perhaps the CV benefits of empagliflozin in the EMPA-REG study can be seen with dapagliflozin in both high as well as low risk patients. This is important for clinical practice as DECLARE, the CV outcome trial with dapagliflozin, is not due to report until 2019.” – by Amber Cox
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Wasim Hanif, PhD, can be reached at wasim.hanif@uhb.nhs.uk.
Disclosure: Hanif reports various financial ties with Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Novo Nordisk, Pfizer and Takeda. Please see the full study for a list of all other authors’ relevant financial disclosures.