Patients in Asia With HFrEF Had Similar Benefit From Dapagliflozin Therapy as Other Patient Populations

Dapagliflozin was found to have similar effects at reducing risk for worsening heart failure (HF) events and cardiovascular deaths among patients living in Asia as non-Asian patients. These findings were published in JACC: Asia.

The Dapagliflozin and Prevention of Adverse-outcomes in Heart Failure (DAPA-HF) trial was a randomized, double-blind trial conducted at 410 centers. Patients (N=4744) with HF with reduced ejection fraction (HFrEF) were randomly assigned to receive dapagliflozin or placebo. This post hoc analysis compared the subset of patients recruited from China, Japan, Taiwan, Vietnam, and India (n=1096) with patients recruited from other countries. The composite outcome was worsening HF and cardiovascular death.

The Asian and non-Asian patients were aged mean 63.3±12.4 and 67.2±10.2 years (P <.001); 19.0% and 24.7% were women (P <.001); 75.4% and 65.2% had New York Heart Association functional class II (P <.001); heart rate was 74.3±12.0 and 70.6±11.5 beats/min (P <.001); systolic blood pressure was 118.3±16.3 and 122.9±16.2 mm Hg (P <.001); and left ventricular ejection fraction was 30.5%±6.6% and 31.2%±6.8% (P =.001), respectively.

Compared with the patients enrolled outside of Asia, risk for the primary composite endpoint did not differ (adjusted hazard ratio [aHR], 1.19; 95% CI, 0.99-1.42; P =.06).

Stratified by individual endpoints, risk for cardiovascular death (aHR, 0.98; 95% CI, 0.77-1.26; P =.90), worsening HF event (aHR, 1.22; 95% CI, 0.98-1.53; P =.08), all-cause mortality (aHR, 0.93; 95% CI, 0.74-1.17; P =.56), and total HF hospitalizations and cardiovascular death (aHR, 1.13; 95% CI, 0.93-1.37; P =.23) did not differ among the patients recruited in Asia.

Stratified by regions in Asia, dapagliflozin was favored for the composite primary outcome among patients recruited in East Asia (HR, 0.61; 95% CI, 0.43-0.86) but only tended to be favored among those from South Asia (HR, 0.87; 95% CI, 0.45-1.72) or South-East Asia (HR, 0.69; 95% CI, 0.26-1.85).

No interactions were observed for changes to estimated glomerular filtration rate (P =.83), systolic blood pressure (P =.69), hematocrit (P =.82), or weight (P =.90) on the basis of recruitment location.

Similarly, the Asian patients did not differ from patients enrolled outside of Asia with regards to the safety profile of empagliflozin.

This analysis was limited by the relatively modest number of patients who were recruited in Asia overall.

“In the DAPA-HF trial, dapagliflozin, compared with placebo, reduced the risk of worsening HF events, cardiovascular death, and all-cause death, and improved symptoms, to the same extent in Asian patients as patients from other geographic regions,” the study authors wrote. “These findings provide further support for the use of dapagliflozin as a new treatment option for Asian patients with HFrEF.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Docherty KF, Anand IS, Chiang C-E, et al. Effects of Dapagliflozin in Asian patients with heart failure and reduced ejection fraction in DAPA-HF. JACC Asia. Published online March 29, 2022. doi:10.1016/j.jacasi.2022.02.004