Extended Indications for Dapagliflozin

Dapagliflozin has recently been approved for the treatment of symptomatic heart failure. Dapagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor originally only indicated for the management of type 2 diabetes mellitus.

Initial safety trials of dapagliflozin suggested a reduced cardiovascular risk, which was further investigated in the DAPA-HF Trial. In this trial, patients with heart failure and an ejection fraction of ≤40% were randomly assigned to receive dapagliflozin 10mg daily or placebo, in addition to standard therapy. The primary outcome, a composite of worsening heart failure or cardiovascular death, occurred in 16.3% of the dapagliflozin group compared to 21.2% of the placebo group. There was no significant difference between the two groups in the incidence of adverse effects related to volume depletion, renal dysfunction, or hypoglycaemia. Interestingly, the cardiovascular benefits of dapagliflozin were observed regardless of diabetes status.

For the treatment of heart failure, dapagliflozin should be administered in conjunction with individualised standard of care therapy. Dapagliflozin is currently only subsidised on the Pharmaceutical Benefits Scheme (PBS) for the treatment of type 2 diabetes mellitus.