제2형 당뇨병에서 얼투글리플로진 (스테글라트로)과 심혈관 결과, Ertugliflozin (Steglatro) and CV outcomes in T2DM

Ertugliflozin and cardiovascular outcomes in type 2 diabetes

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스테글라트로 (얼투글리플로진)는 ASCVD와 당뇨병 환자에서 심혈관 원인에 의한 사망, 비치명적 심근경색, 비치명적 뇌졸중의 primary composite endpoint를 줄이지 못했습니다.

In patients with established cardiovascular or renal comorbidities, sodium-glucose co-transporter 2 (SGLT2) inhibitors have demonstrated benefit for cardiorenal outcomes. In a placebo-controlled trial of ertugliflozin in over 8000 individuals with type 2 diabetes (mean A1C 8.2 percent) and prevalent atherosclerotic cardiovascular disease (ASCVD), the primary composite endpoint of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke was similar between groups (11.9 percent in each group). As in other SGLT2 trials, ertugliflozin reduced heart failure hospitalizations and some renal outcomes. In the absence of contraindications, we continue to prefer SGLT2 inhibitors for patients with diabetes when heart failure and/or albuminuric chronic kidney disease are the predominant comorbidities, rather than ASCVD.

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ASCVD와 당뇨병이 있는 환자에서 권고하는 SGLT2억제제 중에 얼투글리플로진 (스테글라트로)은 포함되지 않음

SGLT2 inhibitors play a role in the following settings (the specific drugs listed have been demonstrated to have significant beneficial effects in placebo-controlled clinical trials): ▶ In patients with overt atherosclerotic cardiovascular disease (CVD) not reaching glycemic goals with metformin and lifestyle modifications (empagliflozin, canagliflozin, and dapagliflozin, but not ertugliflozin) ▶ In patients with heart failure not reaching glycemic goals with metformin and lifestyle modifications (empagliflozin, canagliflozin, dapagliflozin, and ertugliflozin) ▶ In patients with urine albumin-to-creatinine ratio >300 mg/g and estimated glomerular filtration rate [eGFR] <90 mL/min/1.73 m2 (canagliflozin, dapagliflozin)

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즉, 당뇨병 환자에서 SLGT2억제제를 선택해야 할 때 카나글리플로진, 다파글리플로진, 엠파글리플로진, 얼투글리플로진이 모두 이용 가능한 선택이 될 수 있지만, ASCVD 질환이 있는 경우 얼투글리플로진은 위약보다 우월한 이득을 보여주지 못하였으므로 선택적 약제로서 적절하지 못합니다.

Atherosclerotic cardiovascular disease (CVD) – Empagliflozin and canagliflozin have been shown to decrease atherosclerotic cardiovascular morbidity and mortality in patients with type 2 diabetes and overt CVD. In the primary analysis, dapaglifloxin did not appear to reduce atherosclerotic cardiovascular morbidity or cardiovascular mortality; however, it decreased cardiovascular outcomes in a subanalysis of the primary trial. The cardiovascular trials to date have been carried out in very high-risk populations to increase the hazard rate for major CVD events and complete the studies in a relatively brief period of time. Of note, compared with the empagliflozin and canagliflozin trials, the dapagliflozin trial had a lower fraction of participants with established CVD and a greater proportion of patients with multiple risk factors for CVD (multiple risk factors in 60 percent compared with 0 and 34 percent in the empagliflozin and canagliflozin trials, respectively). This difference in patient population may explain, in part, the differences in atherosclerotic CVD outcomes. However, the ertugliflozin cardiovascular trial only included patients with established CVD and did not show superior benefit in the composite outcome (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke)

ASCVD와 다르게 심부전과 당뇨병이 있는 환자에서는 모두 SGLT2억제제가 유익한 이득을 나타냈습니다. * 그러함에도 불구하고 estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2인 경우에는 ertugliflozin은 사용 금기입니다.

 

REF. UpToDate 2020.12.21