Dapagliflozin now indicated for treatment of heart failure with reduced ejection fraction

Dapagliflozin now indicated for treatment of heart failure with reduced ejection fraction
Sara Maki, Pharm.D., North Memorial Blaine Clinic

Farxiga (dapagliflozin) is a sodium glucose co-transporter two (SGLT2) inhibitor that was first approved as a glucose-lowering agent for use in patients with type two diabetes. The DECLARE-TIMI trial later established that treatment with dapagliflozin could also result in fewer hospitalizations for heart failure in patients with diabetes. This, along with two other cardiovascular outcomes trials of SGLT2 inhibitors -- CANVAS for canagliflozin and EMPA-REG for empagliflozin -- presumably led to the DAPA-HF trial, which studied the rates of cardiovascular death or worsening heart failure in patients on dapagliflozin.

DAPA-HF was a multicenter, randomized, double-blind, placebo-controlled that studied whether the addition of dapagliflozin could benefit patients (n=4744) with heart failure with reduced ejection fraction (HFrEF) and New York Heart Association (NYHA) Class II through IV symptoms, whether or not they had diabetes. With a follow-up period of 18 months, people who received dapagliflozin 10 mg daily had fewer cardiovascular deaths, hospitalizations for heart failure, and urgent care visits for heart failure requiring intravenous diuretic therapy compared to placebo. 

Farxiga (dapagliflozin) is the first SGLT2 inhibitor approved for use in patients with HFrEF. This designation has not yet been incorporated into cardiology clinical guidelines, which were last updated by the American College of Cardiology (ACC) and American Heart Association (AHA) in 2017; however the DAPA-HF trial sheds light on dapagliflozin’s potential new place in therapy. 

References: 

  1. Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2019;380(4):347-357.

  2. McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients With Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019;381(21):1995-2008.