Canagliflozin may have greatest CV benefit in patients with prior HF
ORLANDO, Fla. — Among patients with type 2 diabetes, canagliflozin reduces the risk for CV death or hospitalization for HF to a greater degree in patients with prior HF, according to new data from the CANVAS study presented at the American College of Cardiology Scientific Session.
The study, presented by Gemma Figtree, MBBS, DPhil, from the University of New South Wales and the Royal North Shore Hospital in Sydney, which was simultaneously published in Circulation, reported the effects on HF and CV death overall in patients with and without history of HF.
“We all know that heart failure is a major problem for our patients with diabetes. This is not just in terms of the increased incidence, but also in worse outcomes,” she said during a presentation. “Despite the improvements that we’ve seen … it’s not until recent studies with SGLT2 inhibitors that we’ve really begun to see a difference in outcomes for heart failure.”
The study consisted of 10,142 patients with type 2 diabetes who had increased CV risk factors. As Cardiology Today previously reported, the CANVAS study showed canagliflozin (Invokana, Janssen) was associated with a 33% reduction in HF hospitalizations. For the present analysis, the primary outcome was a composite of CV death or hospitalization for HF. Mean follow-up was 188 weeks.
Patients enrolled with a history of HF at baseline were more frequently women, white and hypertensive, and they had a history of prior CVD (P < .001 for all).
At baseline, many these patients were using therapies such as renin-angiotensin-aldosterone system blockers, diuretics and beta-blockers at baseline (P < .001 for all).
Among patients treated with canagliflozin, CV death or hospitalization HF was reduced compared with placebo (16.3 per 1,000 patient-years vs. 20.8 per 1,000 patient-years; HR = 0.78; 95%; CI, 0.67-0.91), as was fatal HF hospitalization (HR = 0.7; 95% CI, 0.55-0.89) and hospitalization for HF alone (HR = 0.67; 95% CI, 0.52-0.87).
According to the study, the treatment effect of canagliflozin on CV death or hospitalization for HF appears to be greater among patients with a history of HF (HR = 0.61; 95% CI, 0.46-0.8) than those without HF at baseline (HR = 0.87; 95% CI, 0.72-1.06; P for interaction = .021).
The treatment effect of canagliflozin on other CV and safety outcomes was similar in those who did and did not have HF at baseline (all interaction P values > .13), with the exception of reduction in absolute rate of events attributable to osmotic diuresis among those with a prior history of HF (P = .03).
“We can be reassured that there is certainly no worse effect of canagliflozin in those patients, and … the benefits may possibly be greater in these individuals,” Figtree said. – by Dave Quaile
Figtree G, et al. Featured Clinical Research II: Interventional. Presented at: American College of Cardiology Scientific Session; March 10-12, 2018; Orlando, Fla.
Disclosure: The study was funded by Janssen. Figtree reports she receives compensation from Janssen for serving on the adjudication panel of the CANVAS program.