Is Farxiga (dapagliflozin) effective in managing congestive heart failure?

Efficacy of Farxiga (Dapagliflozin) in Congestive Heart Failure

Farxiga (dapagliflozin) is highly effective in managing congestive heart failure across all ejection fraction ranges, reducing the composite risk of cardiovascular death or hospitalization for heart failure by 18-26% regardless of diabetes status. 1, 2

Efficacy Across Heart Failure Types

• Heart Failure with Reduced Ejection Fraction (HFrEF):

  • In the DAPA-HF trial, dapagliflozin 10 mg daily reduced the primary composite outcome of cardiovascular death or hospitalization for heart failure by 26% (HR 0.74 [95% CI 0.65-0.85]; p<0.0001) in patients with LVEF ≤40% 2
  • Benefits appeared within weeks of initiation and were maintained throughout the median 18-month follow-up period 1

• Heart Failure with Preserved Ejection Fraction (HFpEF):

  • In the DELIVER trial, dapagliflozin reduced the primary composite endpoint by 18% (HR 0.82 [95% CI 0.73-0.92]; p=0.0008) in patients with LVEF >40% 2
  • Greatest benefit observed in NYHA class II-III patients with frequent symptoms or hospitalizations 1

Benefits Independent of Key Factors

• Dapagliflozin's efficacy is consistent regardless of:
  • Diabetes status (works equally well in patients with or without diabetes) 1
  • Age and sex 1
  • Background heart failure therapies (including ACE inhibitors/ARBs/ARNI, beta-blockers, MRAs) 1, 3
  • Severity of heart failure (effective even in severe heart failure) 3

Specific Clinical Benefits

• Hospitalization for Heart Failure:

  • 30% reduction in heart failure hospitalizations in HFrEF (HR 0.70 [95% CI 0.59-0.83]) 2
  • 23% reduction in heart failure hospitalizations in HFpEF (HR 0.77 [95% CI 0.67-0.89]) 2

• Additional Benefits:

  • May reduce the need for diuretic intensification 1
  • May facilitate use of MRAs by reducing risk of severe hyperkalemia 1
  • Provides kidney protection, with benefits seen in patients with eGFR as low as 25 mL/min/1.73m² 1, 2

Dosing and Administration

• Standard dosing: 10 mg once daily 1
• Renal considerations: Can be used in patients with eGFR ≥25 mL/min/1.73m² 1
• No dose adjustment or up-titration required 1
• Should be withheld at least 3 days before major surgery or procedures requiring prolonged fasting 1

Safety Considerations

• Common adverse effects:

  • Genital mycotic infections
  • Urinary tract infections
  • Volume depletion/hypotension
  • Euglycemic diabetic ketoacidosis (rare but serious) 1

• Monitoring recommendations:

  • Assess renal function and volume status before initiation
  • Monitor for genital tract infections
  • Resume after surgery only when clinically stable with resumed oral intake 1

Guideline Recommendations

The European Society of Cardiology and American College of Cardiology recommend SGLT2 inhibitors, including dapagliflozin, as core treatments for heart failure, particularly for HFrEF, to be added to standard guideline-directed medical therapy 1. These recommendations are based on robust evidence showing significant reductions in cardiovascular death and heart failure hospitalizations across multiple large-scale clinical trials.

Farxiga should be continued indefinitely as part of heart failure management, with benefits appearing greatest in patients with LVEF between 41% and 65% 1.