Yilmaz Mehmet Birhan, Celik Ahmet, Colluoglu Tugce, Sahin Anil, Ural Dilek, Kanik Arzu, Ata Naim, Ulgu Mustafa Mahir, Birinci Şuayip
Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, Izmir, Türkiye.
Department of Cardiology, Faculty of Medicine, Mersin University, Mersin, Türkiye.
Am J Cardiovasc Drugs. 2025 Mar;25(2):277-286. doi: 10.1007/s40256-024-00698-6. Epub 2024 Nov 28.
Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are breakthrough agents for the treatment of type 2 diabetes mellitus (T2DM) and heart failure (HF). However, among patients with HF and T2DM, some uncertainty remains about individual comparisons, including dosing.
We aimed to make a real-life individual comparison of SGLT2is among patients with HF and T2DM.
This was a subgroup analysis of the Turkish Ministry of Health's National Electronic Database for adult patients with HF (TRends-HF). All-cause mortality (ACM) data up to 7 years were evaluated. Patients with HF and T2DM who were prescribed an SGLT2i were identified, and individual doses of empagliflozin 25 mg, empagliflozin 10 mg, and dapagliflozin 10 mg were compared. For individual comparisons, propensity score-matching analysis was generated as 1:1:1, and disease-modifying therapies (DMTs) for HF were considered.
In the triple-matched cohort, 1-, 5-, and 7-year survival rates were 95%, 81%, and 76% versus 94%, 78%, and 72% versus 94%, 80%, and 75% for empagliflozin 25 mg, empagliflozin 10 mg, and dapagliflozin 10 mg, respectively. Among patients who were on triple DMT for HF, 1-, 5-, and 7-year survival rates were 95%, 78%, and 70% for empagliflozin 25 mg, 95%, 74%, and 66% for empagliflozin 10 mg, and 94%, 77%, and 69% for dapagliflozin, respectively. Annual emergency department visits were slightly lower with empagliflozin 10 mg and dapagliflozin 10 mg than with empagliflozin 25 mg. A greater proportion of patients on dapagliflozin 10 mg did not experience hospitalization during the 7-year follow-up compared with both doses of empagliflozin, albeit with a small effect size.
Among patients with HF and T2DM, SGLT2is are instrumental, and empagliflozin 10 mg remains significantly inferior to dapagliflozin 10 mg and empagliflozin 25 mg in terms of 5- and 7-year ACM.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）是治疗2型糖尿病（T2DM）和心力衰竭（HF）的突破性药物。然而，在HF和T2DM患者中，包括给药剂量在内的个体比较仍存在一些不确定性。
我们旨在对HF和T2DM患者中的SGLT2i进行真实世界的个体比较。
这是对土耳其卫生部成人HF患者国家电子数据库（TRends-HF）的亚组分析。评估了长达7年的全因死亡率（ACM）数据。确定了开具SGLT2i处方的HF和T2DM患者，并比较了恩格列净25mg、恩格列净10mg和达格列净10mg的个体剂量。对于个体比较，生成倾向评分匹配分析为1:1:1，并考虑了HF的疾病改善疗法（DMT）。
在三重匹配队列中，恩格列净25mg、恩格列净10mg和达格列净10mg的1年、5年和7年生存率分别为95%、81%和76%，94%、78%和72%，94%、80%和75%。在接受HF三联DMT治疗的患者中，恩格列净25mg的1年、5年和7年生存率分别为95%、78%和70%，恩格列净10mg为95%、74%和66%，达格列净为94%、77%和69%。恩格列净10mg和达格列净10mg的年度急诊科就诊次数略低于恩格列净25mg。与两种剂量的恩格列净相比，接受达格列净10mg治疗的患者在7年随访期间未住院的比例更高，尽管效应量较小。
在HF和T2DM患者中，SGLT2i发挥着重要作用，就5年和7年ACM而言，恩格列净10mg仍显著低于达格列净10mg和恩格列净25mg。
