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The cardiovascular benefits of SGLT2 inhibitors are now well known. But the case for using these drugs to prevent kidney problems in people with type 2 diabetes is growing. New data on the Astrazeneca farxiga featured the ADA meeting on Sunday. An badysis of the Declare-Timi study of cardiovascular effects previously described by Farxiga, described as both prespecified and exploratory, revealed a 47% reduction in composite renal damage. According to Elisabeth Björk, head of the cardiovascular, renal and metabolic division of Astra, this improvement is linked to improvements in estimated glomerular filtration rates rather than to end-stage nephropathy or death, but there is room for improvement. wait in the wider population. In contrast, the Credence trial of Invokana, a competing SGLT2 inhibitor from Johnson & Johnson, has recently shown renal benefit in sicker patients. Astra hopes that its data could motivate the absorption of Farxiga by primary care physicians, but the renal benefit is beginning to resemble another clbad effect of SGLT2. Asked about the impact of Declare-Timi's data on prescribing, Ms. Björk replied, "I do not see why [SGLT2s] Metformin should not be used as a second-line first line treatment. " Next year, data from Farxiga's Dapa-CKD trial on patients with and without diabetes will be examined carefully.
| Renal outcome data from Declare-Timi, NCT01730534 | |||
|---|---|---|---|
| Period | Farxiga | Placebo | Statistics |
| Specific renal composite * | 1.5% | 2.8% | HR 0.53, p <0.0001 |
| Reduced decline of EGFR | 1.4% | 2 · 6% | HR 0.54, p <0.0001 |
|
Terminal phase of renal disease |
0.1% | 0.2% |
HR 0.31, p = 0.013 |
| Kidney death | 0.1% | 0.1% | HR 0.60, p = 0.32 |
| Cardiovascular Composite ** | 4.3% | 5.6% | HR 0.76, p <0.0001 |
| * Includes deterioration of renal function (sustained decrease ≥ 40% of estimated EGFR up to <60 ml / min), end-stage renal failure or renal death. ** Includes kidney composite and death from cardiovascular origin, reported previously. Source: ADA, The Lancet Diabetes & Endocrinology, June 9, 2019. | |||
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