Alberto Aimo1,2, Konstantinos Pateras3, Kimon Stamatelopoulos4, Antoni Bayes-Genis5,6, Carlo Mario Lombardi7, Claudio Passino8,9, Michele Emdin8,9, Georgios Georgiopoulos4,10. 1. Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124, Pisa, Italy. a.aimo@santannapisa.it. 2. Cardiology Division, University Hospital of Pisa, Piazza Martiri della Libertà 33, 56124, Pisa, Italy. a.aimo@santannapisa.it. 3. Department of Biostatistics and Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. 4. Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece. 5. Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. 6. CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain. 7. Department of Medical and Surgical Specialties, Radiological Sciences, Public Health University and Civil Hospital, Brescia, Italy. 8. Institute of Life Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124, Pisa, Italy. 9. Cardiology Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy. 10. School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
Abstract
BACKGROUND: Sacubitril/valsartan, vericiguat, and the sodium-glucose co-transporter-2 inhibitors (SGLT2i) dapagliflozin and empagliflozin proved effective in phase 3 trials on heart failure with reduced ejection fraction (HFrEF). METHODS: We compared the treatment arms (sacubitril/valsartan, vericiguat, and SGLT2i) with the respective control arms (standard-of-care [SOC]) through a network meta-analysis of the phase 3 trials (PARADIGM-HF, VICTORIA, DAPA-HF, EMPEROR-Reduced), a phase 2 trial on vericiguat and the HFrEF subgroup of DECLARE-TIMI 58. RESULTS: There was a trend towards decreased risk of cardiovascular (CV) death or HF hospitalization with SGLT2i than sacubitril/valsartan (HR 0.92, 95% CI 0.81 to 1.05) and vericiguat (HR 0.83, 95% CI 0.73 to 0.94). A non-significant effect of SGLT2i on CV mortality compared to sacubitril/valsartan (HR 1.04, 95% CI 0.88 to 1.24) and vericiguat (HR 0.88, 95% CI 0.63 to 1.22) was found. SGLT2i demonstrated the greatest effect on HF hospitalization (HR 0.69, 95% CI 0.62 to 0.77) over the SOC, as well as a significant benefit over vericiguat (HR 0.77, 95% CI 0.66 to 0.89), but not over sacubitril/valsartan (HR 0.87, 95% CI 0.75 to 1.02). SGLT2i were ranked as the most effective therapy, followed by sacubitril/valsartan and vericiguat. CONCLUSIONS: Based on an indirect comparison, SGLT2i therapy is not associated with a significantly lower risk of CV death or HF hospitalization or CV death alone compared to sacubitril/valsartan or vericiguat. The risk of HF hospitalization does not differ significantly between patients on SGLT2i or sacubitril/valsartan, while dapagliflozin is superior to vericiguat. REGISTRATION NUMBER: PROSPERO ID 186351.
BACKGROUND: Sacubitril/valsartan, vericiguat, and the sodium-glucose co-transporter-2 inhibitors (SGLT2i) dapagliflozin and empagliflozin proved effective in phase 3 trials on heart failure with reduced ejection fraction (HFrEF). METHODS: We compared the treatment arms (sacubitril/valsartan, vericiguat, and SGLT2i) with the respective control arms (standard-of-care [SOC]) through a network meta-analysis of the phase 3 trials (PARADIGM-HF, VICTORIA, DAPA-HF, EMPEROR-Reduced), a phase 2 trial on vericiguat and the HFrEF subgroup of DECLARE-TIMI 58. RESULTS: There was a trend towards decreased risk of cardiovascular (CV) death or HF hospitalization with SGLT2i than sacubitril/valsartan (HR 0.92, 95% CI 0.81 to 1.05) and vericiguat (HR 0.83, 95% CI 0.73 to 0.94). A non-significant effect of SGLT2i on CV mortality compared to sacubitril/valsartan (HR 1.04, 95% CI 0.88 to 1.24) and vericiguat (HR 0.88, 95% CI 0.63 to 1.22) was found. SGLT2i demonstrated the greatest effect on HF hospitalization (HR 0.69, 95% CI 0.62 to 0.77) over the SOC, as well as a significant benefit over vericiguat (HR 0.77, 95% CI 0.66 to 0.89), but not over sacubitril/valsartan (HR 0.87, 95% CI 0.75 to 1.02). SGLT2i were ranked as the most effective therapy, followed by sacubitril/valsartan and vericiguat. CONCLUSIONS: Based on an indirect comparison, SGLT2i therapy is not associated with a significantly lower risk of CV death or HF hospitalization or CV death alone compared to sacubitril/valsartan or vericiguat. The risk of HF hospitalization does not differ significantly between patients on SGLT2i or sacubitril/valsartan, while dapagliflozin is superior to vericiguat. REGISTRATION NUMBER: PROSPERO ID 186351.
Authors: Yao Neng Teo; Yao Hao Teo; Nicholas L Syn; Celine Shuen Yin Yoong; Alex Jia Yang Cheong; Caitlin Fern Wee; Yoke-Ching Lim; Chi-Hang Lee; Tiong-Cheng Yeo; Ping Chai; Raymond C C Wong; Weiqin Lin; Ching-Hui Sia Journal: Clin Drug Investig Date: 2021-11-19 Impact factor: 2.859
Authors: Giuseppe M C Rosano; Simone Celant; Pier Paolo Olimpieri; Antonietta Colatrella; Graziano Onder; Andrea Di Lenarda; Giuseppe Ambrosio; Gianpaolo Reboldi; Gian Franco Gensini; Furio Colivicchi; Pierluigi Russo Journal: Eur J Heart Fail Date: 2022-03-31 Impact factor: 17.349