Effects of dapagliflozin in DAPA-HF according to background heart failure therapy
Effects of dapagliflozin in DAPA-HF according to background heart failure therapy
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DOI：
10.1093/eurheartj/ehaa183
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发表时间：
2020-07-01
影响因子：
39.3
通讯作者：
McMurray, John J., V
中科院分区：
文献类型：
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作者：
Docherty, Kieran F.;Jhund, Pardeep S.;McMurray, John J., V
在DAPA-HF试验中，SGLT 2抑制剂达格列净降低了心力衰竭（HF）恶化和心力衰竭（HF）患者的死亡风险，并降低了射血分数。我们检查是否这种好处是一致的背景HF therapeutic.Methods和结果在这个事后分析中，我们研究了以下是/否亚组的研究治疗的效果：利尿剂，地高辛，盐皮质激素受体拮抗剂（MRA），沙库比曲/缬沙坦，伊伐布雷定，植入式心律转复除颤器（ICD）设备，和心脏起搏治疗。我们还根据血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂剂量、β受体阻滞剂（BB）剂量和MRA（>= 50%和= 50%推荐剂量）检查了研究药物的作用。总体而言，达格列净与安慰剂的主要复合终点风险比（HR）为0.74 [95%置信区间（CI）0.65-0.85]（P < 0.0001）。达格列净的效果在所有亚组中一致：主要终点的HR范围为0.57 - 0.86，无显著的随机治疗与亚组相互作用。例如，基线时服用RAS阻滞剂、BB和MRA的患者的HR为0.72（95%CI 0.61-0.86），而未接受所有三种治疗的患者的HR为0.77（95%CI 0.63-0.94）（P-交互作用0.64）。
Aims In the DAPA-HF trial, the SGLT2 inhibitor dapagliflozin reduced the risk of worsening heart failure (HF) and death in patients with HF and reduced ejection fraction. We examined whether this benefit was consistent in relation to background HF therapy.Methods and results In this post hoc analysis, we examined the effect of study treatment in the following yes/no subgroups: diuretic, digoxin, mineralocorticoid receptor antagonist (MRA), sacubitril/valsartan, ivabradine, implanted cardioverter-defibrillating (ICD) device, and cardiac resynchronization therapy. We also examined the effect of study drug according to angiotensin-converting enzyme inhibitor/angiotensin receptor blocker dose, beta-blocker (BB) dose, and MRA (>= 50% and = 50% of the recommended dose. Overall, the dapagliflozin vs. placebo hazard ratio (HR) was 0.74 [95% confidence interval (CI) 0.65-0.85] for the primary composite endpoint (P < 0.0001). The effect of dapagliflo-zin was consistent across all subgroups examined: the HR ranged from 0.57 to 0.86 for primary endpoint, with no significant randomized treatment-by-subgroup interaction. For example, the HR in patients taking a RAS blocker, BB, and MRA at baseline was 0.72 (95% CI 0.61-0.86) compared with 0.77 (95% CI 0.63-0.94) in those not on all three of these treatments (P-interaction 0.64).Conclusion The benefit of dapagliflozin was consistent regardless of background therapy for HF.