Adriaan Voors, MD, University Medical Center Groningen, the Netherlands, discusses how and why sodium-glucose co-transporter 2 (SGLT2) inhibitors act so quickly for patients with heart failure.
Adriaan Voors, MD, professor of cardiology and director of the Heart Failure Clinic, University Medical Center Groningen, the Netherlands, discusses how and why sodium-glucose co-transporter 2 (SGLT2) inhibitors act so quickly for patients with heart failure.
Can you explain why SGLT2 inhibitors work so quickly?
On the one hand, yes, they work quickly. As you can see in the chronic trials, the survival curves separate really from early on. If I’m honest, with the survival curves that we’ve seen with traditional end points, the time to death and heart failure event, which were nonprespecified end points, were significantly reduced. If you look at the Kaplan Meier curves, they separate only after 15 days, and if it were only the diuretic effects, I would have expected it to be more prevalent already in hospital to get a more early separation of the curves.
Now, we haven’t looked at the quality of life over time. We will have secondary manuscripts; that’s one of the very important ones we will be currently looking at. So it might be that improvement in the symptoms might be early on, but in the heart clinical endpoints like death or hospital readmission, the curves separate only after 15 days—so that may be indicating something else is going on with these drugs as well, besides decongestant and diuresis.