PracticeUpdate: Conference Series | ADC 2018

CVD-REAL 2: SGLT2 Inhibitors Associated With Lower CV Risk vs Other Glucose- Lowering Drugs The large-scale, real-world data reveal that the CV effects of SGLT2 inhibitors may extend across a large population of patients with type 2 diabetes. BY THE PRACTICEUPDATE EDITORIAL TEAM

R eal-world evidence of more than 400,000 patients with type 2 diabetes (T2D) across Asia-Pacific, Canada and the Middle East has shown that those who initiated SGLT2 inhibitors had lower risks of heart failure hospitalization, death and major cardiovascular (CV) events com- pared with those on other glucose-lowering drugs. These findings suggest that the CV effects of SGLT2 inhibitors may extend across patient ethnic and racial backgrounds, geographic regions, and across the CV risk continuum, said Jonathan Shaw, MD, FRACP, FRCP, FAAHMS, who presented results of the CVD-REAL 2 study. Cardiovascular disease (CVD) is the leading cause of death in people with T2D. Several clinical trials of SGLT2 inhibitors have shown a significant reduction in CV events, death, and hospitalizations due to heart failure in T2D patients with CVD taking these drugs. However, these trials recruited patients mostly in Western Europe and the US and, as such, may

not be generalizable to patients in other parts of the world where patient characteristics, treatment patterns and CV events may differ. In CVD-REAL 2, researchers analyzed observational data from 470,128 people with T2D undergoing routine care in six different countries – South Korea, Japan, Singapore, Israel, Australia, and Canada – for a range of CV outcomes: all-cause death, heart failure hospitalization, myocardial infarction, and stroke. “CVD-REAL 2 examined the association of the ini- tiation of SGLT2 inhibitors with mortality and CV outcomes. Like the clinical trials (of SGLT2 inhibi- tors), there was a significantly better outcome for those initiated on SGLT2 inhibitors than for other glucose-lowering drugs, after adjustment for a wide range of potential confounders,” said Dr. Shaw, who is Deputy Director of Clinical and Population Health at the Baker Heart and Diabetes Institute in Melbourne, Australia. Initiation of SGLT2 inhibitors versus other glu- cose-lowering drugs reduced risk of death by 49% (pooled HR, 0.51; 95% CI, 0.37–0.70; P < .001), heart failure hospitalization by 36% (HR, 0.64; 95% CI, 0.50–0.82; P = .001), and death or heart failure hos- pitalization by 40% (HR, 0.60; 95% CI, 0.47–0.76; P < .001). Risk of myocardial infarction (HR, 0.81; 95% CI, 0.74–0.88; P < .001) and stroke (HR, 0.68; 95% CI, 0.55–0.84; P < .001) were also modestly, but significantly, lower in patients on SGLT2 inhibitors versus other glucose-lowering drugs.

" …it would appear that these benefits are a class effect, and may also extend to those people without prior CVD, although this requires confirmation in clinical trials. "

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