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Empagliflozin recommended by NICE as an option in chronic heart failure

12th October 2023

NICE has recommended empagliflozin as a treatment option for some patients with chronic heart failure.

The drug (brand name Jardiance) can be considered as an option for treating symptomatic chronic heart failure with preserved or mildly reduced ejection fraction in adults, final draft guidance states.

It becomes the second NICE-recommended treatment for the condition after the approval in June of dapagliflozin, which was also approved in the EU in February

The European Commission granted marketing authorisation for empagliflozin as a treatment for adults with symptomatic chronic heart failure in March 2022.

An estimated 150,000 people in the UK will now be eligible for treatment with empagliflozin, which should be started on the advice of a heart failure specialist, NICE said.

If a clinician considers empagliflozin to be one of a range of suitable treatments, including dapagliflozin, they should opt for the least expensive after discussing the advantages and disadvantages with the patient.

This should include taking into account the administration costs, dosage, price per dose and commercial arrangements, NICE said.

Chronic heart failure with preserved or mildly reduced ejection fraction is usually treated with standard care such as loop diuretics and treatment for other conditions the person may have, the committee said.

But given dapagliflozin is already recommended as an option, empagliflozin works in a similar way and would be offered to the same population, NICE added.

Evidence presented to the committee showed that empagliflozin plus standard care reduces the combined risk of dying from cardiovascular causes or likelihood of first hospitalisation for heart failure compared with placebo plus standard care, the guidelines said.

But there is no clinical trial evidence directly comparing empagliflozin with dapagliflozin and there were differences in how the trials were done and populations used.

‘When adjustments for these differences are made, an indirect comparison suggests the treatments have similar clinical effectiveness and a similar effect on quality of life,’ NICE said.

Other analyses also suggest the two drugs are associated with similar costs with list prices the same for both at £477.30.

In the first round of draft guidance empagliflozin had not been approved because of uncertainties over cost-effectiveness.

A version of this article was originally published by our sister publication Pulse.

EU approves dapagliflozin across all ejection fractions in heart failure

10th February 2023

Dapagliflozin is a sodium-glucose co-transporter 2 inhibitor which has received EU approval for use in symptomatic chronic heart failure

The anti-diabetic drug, dapagliflozin (brand name Forxiga) has been approved in the EU for patients with heart failure across the full spectrum of ejection fractions its manufacturer AstraZeneca has announced.

It has been estimated that globally, 64.3 million people are living with heart failure and chronic heart failure represents a leading cause of hospitalisation among those 65 years and older. Although dapagliflozin, which is a sodium-glucose cotransporter-2 inhibitor, used in the management of type 2 diabetes, it also appears to reduce adverse outcomes in patients with heart failure. In fact, studies have shown how the drug is effective in type 2 diabetics and heart failure, with an ejection fraction of less than 40%. Furthermore, in pursuing the value of the drug in heart failure, more recent data show that dapagliflozin at a dose of 10 mg daily, was able to reduce the combined risk of worsening heart failure and cardiovascular death in patients with either a mildly reduced or preserved ejection fraction.

Dapagliflozin use across heart failure ejection fractions

In a patient-level pooled analysis of the only two trials which tested dapagliflozin in heart failure with ejection fractions either ≤40% or >40%, there was no evidence that the effect of the drug varied by ejection fraction. In fact, the combined analysis revealed how dapagliflozin reduced both the risk of cardiovascular death and hospitalisations for heart failure.

The drug is now approved in the EU for use in type 2 diabetes, chronic heart failure and in adults with chronic kidney disease.