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SGLT2 inhibitors should be recommended in patients with one or more of the three diseases: type 2 diabetes, chronic kidney disease, and HFrEF

Published:March 12, 2021DOI:https://doi.org/10.1016/j.ejim.2021.03.001
      Patoulias and colleagues have made a relevant commentary entitled “Chronic kidney disease and diabetes status do not affect efficacy of SGLT-2 inhibitors in patients with heart failure with reduced ejection fraction” [
      • Patoulias D
      • Papadopoulos C
      • Doumas M.
      Chronic kidney disease and diabetes status do not affect efficacy of SGLT-2 inhibitors in patients with heart failure with reduced ejection fraction.
      ] on our meta-analysis [
      • Qiu M
      • Ding LL
      • Zhan ZL
      • Zhou HR.
      Do four SGLT2 inhibitors lead to different cardiorenal benefits in type 2 diabetes, in chronic heart failure, and in chronic kidney disease?.
      ] recently published in the European Journal of Internal Medicine (EJIM). In that commentary, the authors, by implementing a further meta-analysis, assessed whether chronic kidney disease (CKD) status and type 2 diabetes (T2D) status affected the efficacy of sodium-glucose transporter 2 (SGLT2) inhibitors in patients with heart failure and reduced ejection fraction (HFrEF). Although a previous meta-analysis [
      • Zannad F
      • Ferreira JP
      • Pocock SJ
      • Anker SD
      • Butler J
      • Filippatos G
      • et al.
      SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials.
      ] has already revealed that SGLT2 inhibitors significantly lower the risk of the heart failure (HF) composite outcome of cardiovascular death (CVD) or hospitalization for heart failure (HHF) in HFrEF patients regardless of CKD status and T2D status, meta-analysis conducted in Patoulias et al.’s commentary [
      • Patoulias D
      • Papadopoulos C
      • Doumas M.
      Chronic kidney disease and diabetes status do not affect efficacy of SGLT-2 inhibitors in patients with heart failure with reduced ejection fraction.
      ] additionally reveals that SGLT2 inhibitors significantly lower the risk of CVD and all-cause death (ACD) in HFrEF patients regardless of CKD status. However, Patoulias et al.’s meta-analysis [
      • Patoulias D
      • Papadopoulos C
      • Doumas M.
      Chronic kidney disease and diabetes status do not affect efficacy of SGLT-2 inhibitors in patients with heart failure with reduced ejection fraction.
      ] failed to completely clarify the issue of SGLT2 inhibitors for the treatment of patients with two or three of the three kinds of diseases: T2D, CKD, and HF. Thus, we intended to do an overall review of the efficacy of SGLT2 inhibitors in two or three concomitant diseases based on the current compelling evidence, to extend the findings of our original meta-analysis [
      • Qiu M
      • Ding LL
      • Zhan ZL
      • Zhou HR.
      Do four SGLT2 inhibitors lead to different cardiorenal benefits in type 2 diabetes, in chronic heart failure, and in chronic kidney disease?.
      ] and Patoulias et al.’s meta-analysis [
      • Patoulias D
      • Papadopoulos C
      • Doumas M.
      Chronic kidney disease and diabetes status do not affect efficacy of SGLT-2 inhibitors in patients with heart failure with reduced ejection fraction.
      ].
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