Possibilities of dapagliflozin in cardio-reno-metabolic protection in patients with and without type 2 diabetes mellitus

DOI: https://dx.doi.org/10.18565/pharmateca.2021.12.53-59

M.B. Antsiferov (1), O.M. Koteshkova (1), M.S. Novikova (1), N.A. Demidov (2)

1) Endocrinological Dispensary of the Moscow Healthcare Department, Russia; 2) Hospital in Moskovsky town of the Moscow Healthcare Department, Moscow, Russia, Russia
The drugs of the class of sodium-glucose co-transporter type 2 (SGLT-2) inhibitors have been used for a long time as hypoglycemic drugs. The hypoglycemic effect of this class of drugs is based on the predominant selective reversible inhibition of SGLT-2, which leads to a decrease in the reabsorption of glucose and sodium from the glomerular filtrate in the renal tubules, excretion of glucose and sodium in the urine and osmotic diuresis. Dapagliflozin, the first representative of the SGLT-2 inhibitors, which was registered on the territory of the Russian Federation, has been studied in patients with type 2 diabetes mellitus (T2DM) in detail. Further evaluation of the effects of SGLT-2 inhibitors in T2DM patients showed their additional beneficial effect on cardiovascular and renal outcomes. Meta-analysis of three large randomized clinical trials, DECLARE-TIMI 58 (dapagliflozin), EMPA-REG OUTCOME (empagliflozin), and CANVAS (canagliflozin), estimating the incidence of cardiovascular and renal outcomes in the pooled population of T2DM patients (n=34,322), has revealed that the use of SGLT-2 inhibitors is associated with a decrease in the relative risk of significant cardiovascular events (nonfatal stroke, nonfatal myocardial infarction, cardiovascular death) by 11%, hospitalization for heart failure by 31% and the progression of renal failure by 45%. In late April 2021, the US Food and Drug Administration (FDA) approved dapagliflozin to reduce the risk of renal and cardiovascular events in patients with chronic kidney disease (CKD) who are at risk of disease progression, regardless of the presence of T2DM. This makes dapagliflozin the first SGLT-2 inhibitor approved for the treatment of CKD in adult patients regardless of diabetic status.

About the Autors

Corresponding author: Nikolai A. Demidov, Cand. Sci. (Med.), endocrinologist, Moskovsky City Hospital of the Moscow Healthcare Department, Moscow, Russia; nicolay13@mail.ru

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