Effect of Dapagliflozin in DAPA-HF According to Background Glucose-Lowering Therapy

Abstract

Objective: To determine whether the benefits of dapagliflozin in patients with heart failure and reduced ejection fraction (HFrEF) and type 2 diabetes in the Dapagliflozin And Prevention of Adverse-Outcomes in Heart Failure trial (DAPA-HF) varied by background glucose-lowering therapy (GLT).

Research design and methods: We examined the effect of study treatment by the use or not of GLT and by GLT classes and combinations. The primary outcome was a composite of worsening heart failure (hospitalization or urgent visit requiring intravenous therapy) or cardiovascular death.

Results: In the 2,139 type 2 diabetes patients, the effect of dapagliflozin on the primary outcome was consistent by GLT use or no use (hazard ratio 0.72 [95% CI 0.58-0.88] vs. 0.86 [0.60-1.23]; interaction P = 0.39) and across GLT classes.

Conclusions: In DAPA-HF, dapagliflozin improved outcomes irrespective of use or no use of GLT or by GLT type used in patients with type 2 diabetes and HFrEF.

Trial registration: ClinicalTrials.gov NCT03036124.

Figure 1

Effect of dapagliflozin compared with placebo on the risk of the primary composite outcomes by background GLT in patients with diabetes. The primary outcome was a composite of worsening heart failure (hospitalization or an urgent visit resulting in intravenous therapy for HF) or death from cardiovascular causes. Patients on multiple glucose-lowering medications are included in each individual medication subgroup. A total of 12 patients were prescribed saxagliptin. *The overall effect was calculated in all randomized patients (n = 4,744).