Heart Failure End Points in Cardiovascular Outcome Trials of Sodium Glucose Cotransporter 2 Inhibitors in Patients with Type 2 Diabetes Mellitus: A Critical Evaluation of Clinical and Regulatory Issues

Javed Butler*, Milton Packer, Stephen J. Greene, Mona Fiuzat, Stefan D. Anker, Kevin J. Anstrom, Peter E. Carson, Lauren B. Cooper, Gregg C. Fonarow, Adrian F. Hernandez, James L. Januzzi, Mariell Jessup, Rita R. Kalyani, Sanjay Kaul, Mikhail Kosiborod, Jo Ann Lindenfeld, Darren K. McGuire, Marc S. Sabatine, Scott D. Solomon, John R. TeerlinkMuthiah Vaduganathan, Clyde W. Yancy, Norman Stockbridge, Christopher M. O'Connor

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations

Abstract

Following regulatory guidance set forth in 2008 by the US Food and Drug Administration for new drugs for type 2 diabetes mellitus, many large randomized, controlled trials have been conducted with the primary goal of assessing the safety of antihyperglycemic medications on the primary end point of major adverse cardiovascular events, defined as cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Heart failure (HF) was not specifically mentioned in the US Food and Drug Administration guidance and therefore it was not a focus of these studies when planned. Several trials subsequently showed the impact of antihyperglycemic drugs on HF outcomes, which were not originally specified as the primary end point of the trials. The most impressive finding has been the substantial and consistent risk reduction in HF hospitalization seen across 4 trials of sodium glucose cotransporter 2 inhibitors. However, to date, these results have not led to regulatory approval of any of these drugs for a HF indication or a recommendation for use by US HF guidelines. It is therefore important to explore to what extent persuasive treatment effects on nonprimary end points can be used to support regulatory claims and guideline recommendations. This topic was discussed by researchers, clinicians, industry sponsors, regulators, and representatives from professional societies, who convened on the US Food and Drug Administration campus on March 6, 2019. This report summarizes these discussions and the key takeaway messages from this meeting.

Original languageEnglish (US)
Pages (from-to)2108-2118
Number of pages11
JournalCirculation
Volume140
Issue number25
DOIs
StatePublished - Dec 17 2019

Keywords

  • biomarkers
  • clinical trial
  • diabetes mellitus, type 2
  • heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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