10 NEWS
10 NEWS
15 SEPTEMBER 2023 ausdoc . com . au
Semaglutide benefit in HFpEF ?
Rachel Fieldhouse SEMAGLUTIDE may be a new therapeutic option for obesity-related heart failure with preserved ejection fraction , with results from a landmark study showing substantial reductions in symptom burden .
The Novo Nordisk – funded trial found that patients given the GLP-1 receptor agonist had a twofold improvement in
symptoms and physical limitations , as well as fewer adverse heart failure events , compared with those given placebo .
Patients assigned to once-weekly semaglutide 2.4mg also had an average 13.3 % drop in body weight compared with a 2.6 % reduction in the placebo group , with a betweengroup difference of nearly 11 %.
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Principal investigator and US cardiologist Dr Mikhail Kosiborod said the magnitude of benefits reported “ is the largest seen with any agent ” for treating heart failure with preserved ejection fraction ( HFpEF ).
“ This will likely have a significant impact on clinical practice , especially since there is a dearth of efficacious therapies in this vulnerable patient group ,” said
Dr Kosiborod , from Saint Luke ’ s Mid America Heart Institute in Kansas City .
The study — presented at the European Society of Cardiology Congress — included 529 patients ( median age 69 ) with HFpEF and a BMI ≥30 assigned to semaglutide or placebo for 12 months .
Most participants had received beta blockers , diuretics and renin – angiotensin – aldosterone system blockers
at baseline , and half had a history of AF .
In addition to the weight loss , the authors found an average 16.6-point improvement on the Kansas City Cardiomyopathy Questionnaire clinical summary score ( KCCQ-CSS ), which measures symptom burden and physical limitations , in the semaglutide group .
In contrast , those taking placebo had an average 8.7- point improvement on the KCCQ-CSS .
Although the trial was not designed to measure hard end points , there was just one heart failure – related hospitalisation / urgent visit recorded in the semaglutide group compared with 12 in the placebo group .
The researchers also reported significantly greater reductions in CRP , N-terminal pro-B-type natriuretic peptide levels and systolic blood pressure among patients given the GLP-1 receptor agonist than in those given placebo .
The magnitude ‘ is the largest seen with any agent ’.
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References : 1 . Elidel ® Product Information . Date of revision 21 / 02 / 2022 . 2 . Data on file , Viatris recommended retail price . March 2022 .
Elidel ® is a Viatris Company Trademark . Copyright © 2023 Viatris Inc . All rights reserved . Viatris Pty Ltd , Level 1 , 30 The Bond , 30 – 34 Hickson Road , Millers Point NSW , 2000 . ABN 29 601 608 771 . Australia Toll free : 1800 314 527 . ELI-2022-0556 . DH . ELI-003632-00 / AD . Date of preparation : February 2023 .
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“ Collectively , our results indicate that semaglutide may represent a valuable therapeutic approach in the management of [ HFpEF ] in patients with obesity ,” they wrote in The New England Journal of Medicine .
“ These findings support the hypothesis that the range of benefits seen with semaglutide were not simply due to weight loss alone ; rather , the pathophysiological processes that underlie [ HFpEF ] syndrome itself improved at the same time that weight was lost .”
In other findings , those in the placebo group had twice as many serious adverse events , which likely reflected the lower number of cardiac events in the active treatment group .
Dutch cardiologist Dr Yigal Pinto wrote in an accompanying editorial that , while “ relatively small ”, the trial results were encouraging and could add a “ much-needed extra option ” for treatment .
Limitations of the study included the relatively short follow-up , which made it difficult to establish the durability of benefits , as well as the predominantly white population and the small proportion of those receiving SGLT2 inhibitors . N Engl J Med 2023 ; 25 Aug .