Rob Mentz, MD: The CANVAS Study and SGLT2 Inhibitors

Rob Mentz, MD: So, the CANVAS study was a large, cardiovascular outcome study of canagliflozin, which is a diabetes medicine, an SGLT2 inhibitor, so an oral agent. It was to meet the FDA requirement for safety, particularly relevant to this meeting whether we could replicate some of the heart failure benefits seen with other sglt2 inhibitors studies that have been reported out with empagliflozin.

I think that take-home messages are that, increasingly, even within the different diabetes medication classes, there are some drugs that have been shown to be helpful with respect to cardiovascular outcomes and some that have been neutral, and then there have been differential effects for heart failure, some that seem to improve things and some or there might actually be a signal of things getting worse. So, I think [when] trying to bring all this information together with how we actually help manage patients, I think that the European guidelines for heart failure and some of the other guidelines nicely go through how we should approach this of really using metformin as the first therapy, but now also empagliflozin.

And now, adding the additional data from CANVAS, there also appears to be this benefit for heart failure hospitalization, although it wouldn't be the traditionally speaking from a statistical standpoint, as it didn't meet the benchmark to say that there was superiority for heart failure. But I think bringing all this together trying to make a complicated landscape simpler by looking at some of these different approaches is outlined in the guidelines, and focusing on those therapies that are safe, but some that also may actually improve heart failure [as well].