Sodium-glucose co-transporter-2 inhibitors in patients with heart failure. What's new? What are the prospects?

This review presents the main results of recently (in 2020) published clinical studies investigating additional properties of drugs of the family of sodium-glucose co-transporter type 2 (SGLT2) inhibitors in patients with heart failure (HF). Of these, the most important is the EMPEROR-Reduced study which demonstrates the superiority of empagliflozin over placebo in preventing cardiovascular death and hospitalization for HF in patients with chronic HE with reduced left ventricular ejection fraction (LVEF). An important finding of this study is that, as in a recent study with a similar design with dapagliflozin - DAPA-HF, the benefit of SGLT2 inhibitors was independent on the presence or absence of diabetes mellitus in patients. The use of empagliflozin in patients with acute HF was studied in the EMPA-RESPONSE-AHF pilot study, in which, although there was no difference between placebo and the drug in the effect on the primary endpoint events, there was a clear trend towards improvement in clinical outcomes under the treatment with empagliflozin after 1 and 2 months of follow up. Administration of another member of the SGLT2 inhibitors family - so-tagliflozin - in the SOLOIST-WHF study in patients with diabetes and recent worsening HF (with any LVEF) was associated with a significant decrease in adverse events. In the VERIT CV study, another SGLT2 inhibitor, ertugliflozin, although it had no effect on long-term outcomes in patients with diabetes and cardiovascular disease, was better than placebo in preventing hospitalization for heart failure. Overall, the recently completed studies of SGLT2 inhibitors show that drugs of this family, which already play an important role in the treatment of patients with HF with reduced LVEF, may in the future become an important component of therapy in a wider range of patients with various types of HF.

heart failure, sodium-glucose co-transporter type 2 inhibitors, empagliflozin, dapagliflozin, sotagliflozin, cardiovascular death