Updated: May 7
May 6, 2020
The US Food and Drug Administration (FDA) has come through with the widely anticipated approval of dapagliflozin (Farxiga, AstraZeneca) for heart failure and reduced ejection fraction (HFrEF), adding to the rich array of medications lately available for this indication.
The approval follows the agency's priority review of the sodium-glucose cotransporter 2 (SGLT2) inhibitor for reducing the risk of cardiovascular (CV) death and heart-failure hospitalization in adults with HFrEF following last year's seminal results of the DAPA-HF trial.
In that study, treatment with dapagliflozin led to about a one fourth reduction in risk of a primary endpoint consisting primarily of CV death or heart-failure hospitalization in patients with chronic HFrEF, in both those with and without diabetes. The randomized, placebo-controlled trial had entered more than 4700 patients.
And of course, dapagliflozin — traditionally viewed only as an antidiabetic agent — has long been indicated for improvement of glycemic control in adults with type 2 diabetes.
The latest approval for patients with NYHA functional class 3-4 HFrEF makes dapagliflozin the only SGLT2 inhibitor to be indicated for heart failure in the absence of diabetes.
Soon after the DAPA-HF results had been unveiled at a major meeting, heart failure expert Christopher O'Connor, MD, expressed concern that dapagliflozin's uptake for patients with HFrEF would be slow once it gained approval for patients without diabetes.
"We have to think of this as a drug that you would prescribe like an ACE inhibitor, or a beta-blocker, or a mineralocorticoid receptor antagonist, or sacubitril/valsartan [Entresto, Novartis]," O'Connor, Inova Heart and Vascular Institute, Falls Church, Virginia, told theheart.org | Medscape Cardiology.