Mark E. Dunlap, MD: Applying SGLT-2 Inhibitors to Care


The headline drug class has been quickly added to cardiologists' toolsets, amid more and more phase 3 data.

New dapagliflozin phase 3 trial data is headlining major discussions at the Heart Failure Society of American (HFSA) 2019 Scientific Sessions in Philadelphia, PA, this weekend. The findings from the Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction (DAPA-HF) and Dapagliflozin Effect on Symptoms and Biomarkers in Patients with Heart Failure (DEFINE-HF) trials are giving clinicians confidence to prescribe SGLT-2 inhibitor therapy.

But details to how integral the agent class is in cardiovascular care are yet to be definite.

In an interview with MD Magazine® following a DAPA-HF presentation at HFSA 2019, Mark E. Dunlap, MD, director of the Heart Failure Program at MetroHealth System and professor at Case Western Reserve University, explained what the positive findings around SGLT-2 inhibitors mean.

He also discussed how SGLT-2 inhibitors already fit into a physician’s therapeutic decision-making process for patients with heart failure.

MD Mag: What emerging therapies hold the most interest for heart failure care?

Dunlap: Certainly, the SGLT-2 inhibitor story is a fascinating one. A comment was raised by Randall Starling, MD, MPH (of the Cleveland Clinic) about we what now consider optimal care. Clearly, with the explosion of therapies for reduced ejection fraction, our patients are in general receiving suboptimal therapies.

While we still have our challenges, in terms of looking for new agents, this looks like a sort of a winner here. How much is that going to constitute our standard regimen, and how are we going to institute that that standard regimen to the well 6.5 million heart failure patients here in the states and the growing number worldwide?

MD Mag: What is the immediate use of SGLT-2 inhibitors in heart failure care, with regard to new DAPA-HF findings?

Dunlap: For the past 2 decades or more in our area, we’ve really studied new agents in addition to what we know. And that of course was the case with the DAPA-HF trial, because we have an ethical mandate to provide the best known therapies.

So when we have a new agent, it is almost universally tried on top of existing therapies. And I think for the foreseeable future, we are going to remain in that space, in terms of additive therapies.

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