JACC:盐皮质激素受体拮抗剂对恩格列净治疗射血分数保留的心衰患者的效果的影响

2022-03-29 Nebula MedSci原创

达格列净在减少慢性心衰患者的主要终点方面不受是否同时服用盐皮质激素受体拮抗剂的影响。

盐皮质激素受体拮抗剂 (MRAs) 可能有助于减少射血分数保留的心力衰竭 (HF) 患者因心衰发作而住院的风险。在MRA治疗背景下,钠-葡萄糖共转运蛋白2抑制剂在射血分数保留的心衰患者中的作用尚未明确。

本研究是一项国际性、多中心、双盲、平行组、安慰剂为对照的3期试验,旨在探索恩格列净在有无使用MRA的慢性心衰患者中的效果。

招募了NYHA功能II-IV级的慢性心衰成年患者,且要求左心室射血分数>40%,NT-proBNP升高(合并房颤则>900 pg/ml,无房颤则>300 pg/ml)。随机(1:1)分成两组,在其原有治疗基础上,予以恩格列净(10 mg/d)或安慰剂。主要终点是心血管死亡和心衰住院的综合结局(首次发生的时间)。

根据有无使用MRA分组,恩格列净的治疗效果

 

共纳入了5988位患者,其中2244位(37.5%)在基线时有服用MRA。MRA服用者的主要终点事件发生率高于非MRA服用者(安慰剂组主要终点:9.4 vs 8.2 例事件/100人·年)。恩格列净在降低非MRA服用者和MRA服用者的主要结局方面的益处没有显著差异(HR分别是0.73和0.87,p=0.22)。

恩格列净减少首次和复发心力衰竭住院次数的作用在MRA非服用者中比在MRA服用者中更为显著(HR分别是0.60和0.90,p=0.038)。MRA服用者经历的高钾血症事件几乎是非MRA服用者的两倍,无论服用MRA与否,恩格列净都可以降低高钾血症风险,并减少药物排钾的需求(非MRA服用者:HR 0.90;MRA服用者:HR 0.74;p=0.29)。

综上,该研究表明,恩格列净在减少慢性心衰患者的主要终点方面不受是否同时服用盐皮质激素受体拮抗剂的影响。恩格列净在减少首次和复发心力衰竭住院方面的效果在非MRA服用者中更显著。此外,恩格列净可降低高钾血症风险,且不受是否服用MRA的影响。

 

原始出处:

Ferreira Jo?o Pedro,Butler Javed,Zannad Faiez et al. Mineralocorticoid Receptor Antagonists and Empagliflozin in Patients With Heart Failure and Preserved Ejection Fraction.[J] .J Am Coll Cardiol, 2022, 79: 1129-1137. https://doi.org/10.1016/j.jacc.2022.01.029.

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    2022-05-21 hbwxf
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    2022-09-02 小小医者

    盐皮质激素受体拮抗剂对#恩格列净#治疗#射血分数保留心衰#患者的效果的影响

    0

  4. 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    2022-03-29 ms7000000387339206

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