ADDition of DAPAgliflozin, Sodium-Glucose Cotransporter-2 Inhibitor to Angiotensin Receptor Blocker-Neprilysin Inhibitors Non-Responders in Patient with Refractory Heart Failure with Reduced Ejection Fraction (ADD DAPA trial)

Abstract

Objectives We evaluated the efficacy and safety of dapagliflozin, a SGLT2i along with ARNI in refractory HFrEF irrespective of their diabetic status. Methods We performed a retrospective analysis of 104 symptomatic patients of HFrEF despite of optimal medical management with ARNI between January–June 2020. Despite the optimal GDMT, dapagliflozin, SGLT2i was added inpatients withrefractory heart failure. At 6-months follow-up, the primary outcome was change in left ventricular ejection fraction, and secondary outcomes included changes in NYHA functional class, vital parameters, renal function, potassium levels, and NT-pro BNP levels. Results The primary outcomeat 6-months follow-up was a mean change in left ventricular ejection fraction (LVEF) +9.00 ± 0.62 ( p < 0.001). The secondary outcome was a significant improvement (69%) in median NYHA functional class by 2.3 (95% Confidence interval 2.245–2.355) with 92.6% of patients were in NYHA class I and 7.4% were in NYHA class II.Diabetic subgroup reached the HbA1C goal of <7%. None of them had either symptomatic hypotension, hypoglycaemia, dyselectrolaemia, and decline in renal function. The drug was well received by most of the patients. Conclusions Dapagliflozin, an SGLT2i, should be used in symptomatic, refractory HFrEF patients despite the use of ARNI. The combination of ARNI and SGLT2i is well tolerated, but large, randomized trials are needed to prove this hypothesis.

Early initiation of Dapagliflozin and its effect on health related quality of life in acute heart failure: a randomised controlled trial

“…These findings are consistent with a study 15 which evaluated the effect of dapagliflozin in HF with mildly reduced EF. Similar effects of dapagliflzoin were stated by another study 16 which observed a significant improvement in NYHA class with the addition of 10mg dapagliflozin to standard therapy for refractory HF patients.…”

Uso De Inibidores De SGLT-2 No Aumento Da Sobrevida De Pacientes Com Insuficiência Cardíaca Sistólica

“…Assim, demonstra-se que o seu uso está associado a um aumento significativo na sobrevida de pacientes com coração congestivo. O estudo "Dapagliflozin in patients with heart failure and reduced ejection fraction (DAPA-HF)", publicado em 2020, demonstrou que a dapagliflozina adicionada ao tratamento padrão versus o tratamento padrão sozinho promoveu diminuição considerável no risco de hospitalização por IC e na mortalidade cardiovascular em pacientes com ICFEr (JARIWALA et al, 2021).…”

Association between Dapagliflozin, Cardiac Biomarkers and Cardiac Remodeling in Patients with Diabetes Mellitus and Heart Failure

“…Regarding the effect of dapagliflozin on the LVEF, there have been conflicting results. In the ADD DAPA study (ADDition of DAPAgliflozin, Sodium–Glucose Cotransporter-2 Inhibitor to Angiotensin Receptor Blocker-Neprilysin Inhibitors Non-Responders in Patient with Refractory Heart Failure with Reduced Ejection Fraction), a retrospective analysis of 104 patients with HFrEF, dapagliflozin administration for 6 months was found to improve the LVEF [(29 ± 4% to 38 ± 5%; +9.00 ± 0.628%; p < 0.001)] [ 35 ]. In contrast, in the REFORM study, dapagliflozin administration for 12 months had no effect on the LVEF [ 14 ].…”