SGLT2i alone or with DPP4 inhibitors prevents hospitalization due to heart failure

Use of sodium glucose co-transporter 2 inhibitors (SGLT2is) either alone or in combination with dipeptidyl peptidase 4 inhibitors (DPP4is) reduces the risk of hospitalization from heart failure (HHF), a study has shown. In contrast, thiazolidinediones alone or in combination with DPP4is increases HHF risk, but glucose-lowering can help reduce HHF.

A team of investigators sought to examine the impact of antihyperglycaemic medications and their association with HHF in a systematic review and meta-analysis of 40 published randomized controlled trials (RCTs) reporting HHF.

Random additive-effects network meta-analysis revealed that the following drugs were neutral on the risk of HHF: metformin (p=0.55), sulfonylureas (p=0.51), glucagon-like peptide-1 receptor-agonist (p=0.16), and DPP4is (p=0.54).

SGLT2i monotherapy (hazard ratio [HR], 0.68, 95 percent confidence interval [CI], 0.60–0.76; p<0.0001) and SGLT2i plus DPP4i (HR, 0.70, 95 precent CI, 0.60–0.81; p<0.0001) were associated with a reduced risk of HHF.

On the other hand, treatment with thiazolidinediones either as monotherapy (HR, 1.45, 95 percent CI, 1.18–1.78; p=0.0004) or in combination with DPP4is (HR, 1.49, 95 percent CI, 1.18–1.88; p=0.0008) correlated with a higher HHF risk.

Of note, a 1-percent decrease in glycosylated haemoglobin (HbA1c) reduced the risk of HHF by 31.3 percent (95 percent CI, 9–48; p=0.009).

This study was limited by the absence of data to verify drug combinations available for clinical use and to discriminate the effect of medications within each of the therapeutic classes.

“SGLT2is prevent HHF, [but] patients with type 2 diabetes mellitus use multiple antihyperglycaemic drugs to achieve glycosylated haemoglobin (HbA1c) targets,” the investigators said. “In these drug combinations, the risk of HHF is unpredictable and so is the parallel effect of glucose-lowering.”