Although early data on the safety and efficacy of sodium-glucose cotransporter 2 inhibitors (SGLT2is) in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) is promising, significant gaps in knowledge remain, says a new study published in Current Medical Research and Opinion.
SGLTI2is were originally developed to treat individuals with diabetes by blocking glucose from being reabsorbed from the kidneys back into the bloodstream. In recent years, however, SGLT2is have emerged as a potential treatment for a variety of cardiovascular diseases, including ATTR-CM.
In this review, the authors sought to summarize the current evidence supporting the use of SGLT2is in patients with ATTR-CM while also highlighting remaining uncertainties.
Several studies have investigated the ability of SGLT2is to reduce the risk of cardiovascular events and mortality in ATTR-CM. Although some findings have been mixed, SGLT2is appear to be well-tolerated in this patient population and may improve survival and cardiovascular outcomes, the authors explained.
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The authors also evaluated the role of SGLT2i therapy in treating cardiac arrythmias, a major contributor to mortality in patients with ATTR-CM. They found that among individuals with ATTR-CM and arrythmias, SGLT2i treatment reduced the risk of mortality and hospitalization. However, they emphasized that the mechanism contributing to this observation remains unknown.
Furthermore, no randomized clinical trials have yet been conducted to assess SGLT2i use in ATTR-CM, representing a significant limitation in our current understanding of its safety and efficacy in these patients.
Similarly, no studies to date have identified specific biomarkers or genetic variants that may predict a patient’s response to SGLT2is, which is essential to customizing treatment according to unique patient profiles.
“As our understanding of ATTR-CM evolves, integrating SGLT2i into personalized
treatment paradigms holds the potential to transform care for this challenging condition,” the authors concluded.
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