Role of Farxiga (Dapagliflozin) in Managing Type 2 Diabetes with Cardiovascular Disease
Farxiga (dapagliflozin) is strongly recommended for patients with type 2 diabetes and cardiovascular disease as it significantly reduces the risk of major adverse cardiovascular events, heart failure hospitalization, cardiovascular death, and progression of kidney disease. 1, 2
Cardiovascular Benefits
Dapagliflozin has demonstrated significant cardiovascular benefits in patients with type 2 diabetes and established cardiovascular disease:
- Reduction in heart failure hospitalization: Dapagliflozin significantly reduces the risk of hospitalization for heart failure (HR 0.70 [95% CI 0.54–0.90]) 1
- Composite cardiovascular outcomes: Reduces the risk of cardiovascular death or hospitalization for heart failure (HR 0.69 [95% CI 0.57–0.83]) 1
- FDA-approved indication: Specifically approved to reduce hospitalization for heart failure in patients with type 2 diabetes with established cardiovascular disease or multiple cardiovascular risk factors 2
Renal Benefits
Beyond cardiovascular protection, dapagliflozin offers substantial renal protection:
- Chronic kidney disease progression: Reduces the risk of sustained eGFR decline, end-stage kidney disease, and renal death 2
- Albuminuria: Particularly beneficial in patients with elevated urinary albumin-to-creatinine ratio (UACR) >30 mg/g, especially >300 mg/g 1
- Renal function range: Effective across a range of baseline renal function (eGFR 30-90 mL/min/1.73m²) 1
Patient Selection Algorithm
For patients with type 2 diabetes and cardiovascular disease, use this algorithm to determine if Farxiga is appropriate:
First-line consideration: For patients with established atherosclerotic cardiovascular disease, heart failure (particularly HFrEF), or chronic kidney disease 1
Particularly strong indication if patient has any of:
Consider regardless of baseline HbA1c: The cardiovascular and renal benefits appear independent of baseline glycemic control 1
Safety Considerations
Important safety considerations when prescribing dapagliflozin:
- Low hypoglycemia risk: Dapagliflozin has a low risk of hypoglycemia when used as monotherapy or with metformin 3
- Common adverse effects: Genital mycotic infections, particularly in women 3
- Rare but serious adverse effects: Diabetic ketoacidosis (DKA), although rare (HR 10.80 [95% CI 1.39–83.65]) 1
- Contraindications: Not recommended in patients with severe renal impairment (eGFR <30 mL/min/1.73m²) 2
- Foot care: Patients with foot ulcers or at high risk for amputation should receive comprehensive education on foot care and amputation prevention 1
Clinical Implementation
When initiating Farxiga in patients with type 2 diabetes and cardiovascular disease:
- Starting dose: 5 mg once daily, taken in the morning with food 2
- Volume status assessment: Correct volume depletion before initiating therapy 2
- Renal function monitoring: Assess renal function before initiation and periodically thereafter 2
- Patient education: Instruct patients about symptoms of DKA and genital infections 2
Comparative Efficacy
Dapagliflozin compared to other antidiabetic medications for cardiovascular protection:
- SGLT2 inhibitors vs. GLP-1 receptor agonists: Meta-analyses suggest both classes reduce atherosclerotic major adverse cardiovascular events to a comparable degree in patients with established ASCVD 1
- Advantage over DPP-4 inhibitors: DPP-4 inhibitors have not shown cardiovascular benefits relative to placebo 1
- Unique mechanism: Independent of insulin secretion or action, providing complementary therapy when used with other antihyperglycemic drugs 3
Farxiga represents a significant advancement in the management of type 2 diabetes with cardiovascular disease, offering protection beyond glycemic control to reduce cardiovascular and renal complications, ultimately improving patient outcomes and survival.