达帕格利弗洛辛用于心力衰竭和功能恶化的患者
Safia Chatur1, Muthiah Vaduganathan1, Brian L Claggett1
1Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Journal of the American College of Cardiology
|August 27, 2023
概括
在心力衰竭 (HF) 患者中,持续服用达帕格利弗洛辛等-葡萄糖共运输体-2 (SGLT2) 抑制剂是安全有效的,即使功能下降 (eGFR <25 mL/min/1.73 m2). 这种方法可以改善心血管结果,而不会增加安全风险.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學.
- 药理学 药理学是指药理学的学科.
背景情况:
- 建议在心力衰竭 (HF) 管理中使用-葡萄糖共运输体-2 (SGLT2) 抑制剂.
- 慢性病是可能引发的,但随着时间的推移,功能可能会下降.
研究的目的:
- 评价持续使用SGLT2抑制剂的安全性和有效性,用于估计膜过率 (eGFR) 低于启动值的高风患者.
- 评估达帕格利弗洛辛持续治疗对心血管结果和心血管功能下降的HF患者的安全性的影响.
主要方法:
- 对涉及11007名患者的DAPA-HF和DELIVER试验进行了聚合分析.
- 及时更新的考克斯比例危险模型评估了EGFR恶化 (<25毫升/分钟/1.73米2) 与达帕格利弗洛辛治疗结果之间的关联.
主要成果:
- 3.2%的患者经历了EGFR恶化到<25mL/min/1.73m2.2.
- 这些患者患初级综合结局的风险更高 (HR:1.87).
- 达帕格利弗洛辛在患有 (HR:0.53) 和没有 (HR:0.78) eGFR恶化的患者中降低了主要结局风险,没有显著的相互作用 (P=0.17).
- 安全结果,包括停止治疗,在EGFR恶化时更高,但在达帕格利弗洛辛和安慰剂组之间相似.
结论:
- 患有eGFR恶化 (<25毫升/分钟/1.73米2) 的患者面临心血管风险升高,但从持续的达帕格利弗洛辛中受益.
- 在患有功能下降的HF患者中,继续服用达帕格利弗洛辛似乎具有有利的益处风险比率.
更多相关视频
08:15Author Spotlight: Network Pharmacology and Molecular Docking to Decipher the Action of Jiawei Shengjiang San Against Diabetic Kidney Disease
Published on: May 10, 2024
610
06:38Early Detection of Drug-Induced Renal Hemodynamic Dysfunction Using Sonographic Technology in Rats
Published on: March 11, 2016
12.1K
相关概念视频
01:22Heart Failure Drugs: Diuretics
420
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
420
01:11Renal Failure: Dose Adjustments
120
In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
120
01:30Heart Failure V: Medical Management
13
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
13
01:23Dipeptidyl Peptidase 4 Inhibitors
211
Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a...
211
01:22Heart Failure VI: Adjunct Therapies
16
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
16
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
463
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
463