CANVAS analysis supports SGLT2 inhibitor benefits for HF
medwireNews: The latest analysis of the CANVAS trial indicates that the cardiovascular benefits of canagliflozin in patients with type 2 diabetes may be greatest in those with concomitant heart failure (HF).
And these benefits “are likely to be accrued on top of other therapies for heart failure management,” write Gemma Figtree (Royal North Shore Hospital, Sydney, New South Wales, Australia) and study co-authors in Circulation.
CANVAS included 1461 patients who had HF, and these patients more frequently used medications for HF management than the 8681 patients without the condition. For example, 60.1% versus 41.6% were using diuretics and 70.4% versus 50.6% were using beta blockers. They were less frequently using statins and metformin, however.
A greater proportion of patients with HF were female, at 44.4% compared with 34.4% of those without HF, and they were more likely to have retinopathy, neuropathy, nephropathy, and atherosclerotic vascular disease.
The primary composite outcome for the analysis was cardiovascular death or HF hospitalization, and this occurred in 203 patients with HF and 449 of those without. In the overall trial population, being randomly assigned to receive treatment with canagliflozin was associated with a significant 22% reduction in the risk for the combined outcome.
This benefit appeared to be larger in patients with baseline HF than in those without, with the respective risk reductions within these groups being 39% and 13%, and the difference between the two being borderline significant (p=0.021) according to the researchers’ definitions.
The difference was statistically significant for the absolute risk reductions; canagliflozin treatment resulted in reductions of 106.97 and 8.36 events per 1000 patient–years among patients with and without HF, respectively (p=0.003).
“The benefits for heart failure outcomes appeared early during follow-up, suggesting a mode of action driven primarily by volume and hemodynamic effects,” the team observes.
Rates of the treatment-related adverse outcomes of amputation, fracture, volume depletion, and acute kidney injury were similar between patients with and without HF, whereas the increased risk for osmotic diuresis associated with canagliflozin treatment appeared to be confined to patients without HF.
The researchers note that their findings are “mostly comparable to” those from the EMPA-REG OUTCOME trial, of empagliflozin, supporting a class effect of sodium-glucose cotransporter (SGLT)2 inhibitors.
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