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In patients stabilized on tafamidis, SGLT2 inhibitors may be beneficial for improving outcomes of transthyretin amyloid cardiomyopathy (ATTR-CM). Treatment with dapagliflozin was found to be well-tolerated in patients with ATTR-CM.

Transthyretin amyloid cardiomyopathy (ATTR-CM) is a heart disease that can be fatal. In recent years, more and more people have been diagnosed and subsequently hospitalized with the disease. ATTR-CM is marked by the buildup of amyloid protein fibrils in the walls of the left ventricle, which makes the left ventricle stiff and stops it from functioning properly.

Sodium–glucose cotransporter 2 inhibitors (SGLT2i) are the newest class of drugs that have been studied for treating heart failure. Unlike traditional heart failure therapy, SGLT2i don’t seem to lower the heart rate or cardiac output in people with restrictive cardiomyopathies, like ATTR-CM.They also doesn’t seem to have a significant effect on blood pressure. As the safety and tolerability of traditional heart failure medications for ATTR-CM patients have been called into question, SGLT2i represent a promising alternative.

In a recent report in the journal ESC Heart Failure, researchers expressed for the first time that the SGLT2 inhibitor dapagliflozin was well-tolerated by ATTR-CM patients in the short term, that it worked clinically, and improved cardiorenal biomarkers.

Patients with stable ATTR-CM were evaluated retrospectively, in this study. A numerical decrease in cardiorenal biomarker levels was observed at 3-month follow-up in 76.5 % of patients who received dapagliflozin and 67.5 % of patients in the control cohort.

Side effects previously associated with SGLT2i were seen in the study group, and the disease stage, renal function, weight, and use of diuretics all stayed the same. These results suggest that ATTR-CM patients with stable disease are able to tolerate dapagliflozin well. Randomized controlled trials need to be conducted to evaluate the effects of SGLT2i therapy on long-term morbidity and mortality in patients with ATTR-CM.

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Dobner, S., Bernhard, B., Asatryan, B., Windecker, S., Stortecky, S., Pilgrim, T., . . . Hunziker, L. (2022). SGLT2 inhibitor therapy for transthyretin amyloid cardiomyopathy: early tolerance and clinical response to dapagliflozin. ESC Heart Fail. doi:10.1002/ehf2.14188.

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