Chicago – Daphlofflowsen (Farxiga / Forxiga, AstraZeneca) showed an unusual trend on a deficiency in major adverse events (MSE), but reduced the dose of DECLARE-TIMI 58 cases in type 2 diabetes patients.
The American Heart Association (AHA) Scientific Sessions presented a legal action by the Legal Staff in 2018 Vivid, MD, Brigam and Women's Hospital, Harvard Medical School, Boston, Massachusetts. It was published online simultaneously New England Journal of Medicine.
"Other important trials of sodium glucose cotransporter-2 (SGLT2) inhalers are the ones we see in this trial – a significant decrease in heart stroke and renal incidence. " theheart.org Medcity Cardiology.
"DECLARE-TIMI 58, but nothing else [cardiovascular outcomes] Without pre-existing heart surgery, 10,000 patients are at risk for multiple and vulnerable populations, including multiple risk factors, and 7000 patients with cardiovascular disease.
"We have learned that patients with diabetes mellitus have a Daphliffifflowsin, but the secondary resistance group has secondary resistance to the influence of these people without any effect.
"Three SGL 2 Inhaiter Trials have a big impact on the risk of heart failure, and the trial brings together the so-called literature, but the primary immune system of diabetic patients also provides the benefit of this heart disease," said Vivitt.
"The trail is the most beneficial for MAP, but it is less than a stroke-DECLARE-TIMI 58 trial trials, since we are definitely resistant to SGLT2 inhibitors, limiting major blood circulation patients to existing cardiovascular disease patients."
"The safety of the dekure TIMI-58 trauma stroke, amputular, or bladder cancers is very comforting about the security of the symptoms," he added.
Since 2008, the US Food and Drug Administration (FDA) has been conducting a large cardiovascular test (CV) examination of new type 2 diabetes drugs, after concern about CV risk for old Type 2 diabetes drugs.
So far, the eight completed CV None of the test tests have found excessive CV risk from the suspected drugs, and three are actually beneficial.
These include two studies of the oral SGLT2 inhibitors: EMPA-REG OUTCOMES with trial Imagliflós (Jardine, Boehenger Engelheim / Lilly), CanvasInvokana, Jansen). In both studies, all patients have type 2 diabetes and an existing CD or a CD is more susceptible.
Similarly, in the third study, LEADER presents protein-1 (GLP-1) monogram ligamentotide (such as glucone per day)Victoria, Novo Nordic), all patients with type 2 diabetes produce CVD disease (CDV) or kidney defects, or CD-ROM ratios of 60 years and older.
Dealase, which shows the cardiovascular benefit of new diabetes drugs, has now been added to these studies. But its qualities are limited to heart failure, but do not show the same deficiencies as other SGLT2 inhinase trials or leader in MG. However, this trial involves a population that is at risk of type 2 diabetes rather than on pre-existing cardiovascular processes.
In Daplliflozin in DECLARE, get in the bottle
A study conducted in DECLARE-TIMI 58 found that 17,160 patients with Type 2 diabetes, CADV had anemiyserotic CDD or multiple risk factor. The standard therapy was 10 milligrams and dapagglofos at 10 mg dzbs.
Primary safety result CV is a compound of MACE events defined as death, myocardial infarction (MI) or isemic stroke. The end of the two co-primary effectiveness is MACE, cardiovascular death and hospital with cardiovascular disease.
After more than 4.2 years, primary safety resulted in criteria for non-inference.
MAS is estimated as the result of two effectiveness. DAPGlifloxine groups reduced MACE, but the discovery was not important. CV The death toll fell in hospital following a death / stroke. This was the lowest level in the hospital for heart attack.
A major surface product is a semi-solid compound (● 40% less, glomerative filtration rate <1.73 m / 60 mL / min2 Body surface area, new end-stage renal disease, or death from renal or cv). This was less important than dagghliflose.
Table 1. DECLARE-TIMI 58: Main Results
|Variable||Dapagliflozin (%)||Playboy (%)||Hazard Ratio (95% Conference Interval)|
|CV death / MI / stroke||8.8||9.4||0.93 (0.84 – 1.03)|
|CV Hospitalization of Death / Heart Attack||4.9||5.8||0.83 (0.73 – 0.95)|
|Heart attack in hospital||2.5||3.3||0.73 (0.61 – 0.88)|
|CV death||2.9||2.9||0.98 (0.82 – 1.17)|
|Nutritious system||4.3||5.6||0.76 (0.67 – 0.87)|
Once the groups were separated with cardiovascular diseases, MACE was poorly reduced in patients with Diabloflows, but there was no effect on the CDV.
Table 2. Exempt from CDV (for HRD for DigiPlofs)
|Variable||Hazard Ratio (95% Conference Interval)|
|CV death / MI / stroke||0.90 (0.79 – 1.02)||1.01 (0.86 – 1.20)|
|CV Hospitalization of Death / Heart Attack||0.83 (0.71 – 0.98)||0.84 (0.67 – 1.04)|
Diabetic lymphocytes (0.3% vs 0.1%) are more common in diabetics in adverse stages. This is the continuation of the hazardous or serious considerations (0.9% vs 0.1%). Wiviott indicates that these are two side effects of SGLT2 inbits.
He said: "Our results will be relieved, and we do not see any proposals about the increase in infections or strokes along with daphglephlus, which is the largest study of these agents.
"In [EMPA-REG OUTCOMES] The empagliflozin trial, the stroke went into the wrong direction and the convention trial with canagliflozin was the increasing incidence of quotes in the treatment group. Due to these observations from previous experiments, we have carefully evaluated these effects and have no increase in daphliphypose. "
"Dapagliflozin's early studies showed that the urinary cancer drug was in the hands of the FDA and DECLARE trials, and that the diagnosis of diarrhea cancer was actually a small amount of study observations.
CV in diabetes treatment
Vivitt pointed out that this new type 2 diabetes drugs are being infiltrated into the market. "These cardiologists often do not recommend these drugs, but now we have heart related benefits, and I hope their use will increase in the cardiology community in both the patients suffering from primary and secondary defects of diabetes.
"These tests were first performed for the prevention of cardiovascular system, but they showed no heartburn, so these drugs now turn to blood transfusion agents and reduce blood sugar levels rather than diabetic drugs.
"This is a sea shift, and studies with SGLT2 inhibitors, such as heart rate and chronic immunotherapy in diabetic patients."
"Research is taking place in the backward behavior of positive results, which does not result in lowering sugar in the blood," he adds. "They influence the sodium / glucose transcurrence in the kidneys, so the patient has sodium and glucose in urine but they have a direct heart failure," he said.
"Instead of using SGLT 2 incubators, one of these drugs has been shown to have cardiovascular drugs and morbidity benefit when it comes to treating diabetes, which is good for older diabetic drugs, instead of using the SGLT 2 incubator to feel the confidence of using these drugs.
Macrovascular, minivanar reduction events: a range shift
"I also think the effect of diabetes is a model change. To reduce the blood sugar levels, everyone does not have the right precision to reduce blood sugar levels and there is no difference between the different categories [newer] Diabetic medicine, but now we focus on reducing macroascular complications (ie, heart rate consequences). "
DVLR-TIM The test conducted in 58 cases included the most diabetes. Midwife's research firm, CV .
In order to reduce the risk of cardiovascular complications and chronic problems, the benefits of SGLT 2 inhalers in diabetics are being checked again and again.
"We have seen all the experiments, and those who have a heart attack with diabetes." These agents take advantage of MACE, but "this effect is not for patients with cardiac illnesses."
Butler said that the risk of cardiovascular disease is very important for diabetic patients.
Do you know that diabetes can reduce diabetes by working harder or worse, other than the major adverse rehydration programs for diabetes, and more importantly, a heart attack and usually poorly-affecting the risk of cardiovascular disease – smoking, abandonment, low blood pressure, etc. Does not look like that. "
"These tests have now shown that cardiovascular disease patients, multiple cardiovascular risk factors, etc. have shown that these medicines reduce the risk of heart disease."
To theheart.org Medcity Cardiology, Butler added: "The choice between individual SGT 2 inhibitors is difficult. The benefit of cardiovascular diseases with empagliflozin was very impressive – it is difficult to ignore. It seems to be overloading excessive kidney failure and heart failure with all medicines. There has been little increase in the organs of the Conglomerosis. This is only an opportunity, and it does not find it with other SGL 2 inhalers. "
"We have GLP-1 disambiguation drugs that have obvious benefits from serious cardiovascular programs, but I think this is neutral in the heart failure to fail. Both agents are in some cases."
More fascinating view …
However, others make a more awareness view. One of these is David Nathan, director of the diabetes center at Massachusetts's Massachusetts Hospital in Boston, Massachusetts. He said theheart.org Medcity Cardiology: "If this SGLT2 inhibitor is more likely to prevent diabetes, if the risk is higher or less complete risk is minimal – about 1% of patients with major adverse effects on empagliflozin patients show good results.
He points out that all estimates need to be taken into account when considering the use and cost of SGLT2 inhibitors.
"ഈ മരുന്നുകൾ മൂത്രത്തിലും ഗ്ലൂക്കോസിൻറെ മൂത്രത്തിലും വർദ്ധനവുണ്ടാകുന്നു, ഇത് മൂത്രനാളിക അണുബാധകളിലേയ്ക്ക് നയിക്കുന്നു.അവ വാസ്തവത്തിൽ വളരെ വിലകുറഞ്ഞ ഡൈയൂററ്റിക്സ് ആണാണോ എന്ന് നമുക്ക് ചോദിക്കാം – കുറഞ്ഞ ഫലത്തിൽ ഫറോസ്മീഡ് അല്ലെങ്കിൽ തയാസൈഡ് ഡൈറൈറ്റിക് ഇഫക്റ്റുകളും വളരെ കുറഞ്ഞ വിലയും? "
ഹയാലോബ്ബിൻ A1c (HbA1c) ൽ 0.4% കുറവുള്ള ഡാപഗ്ലിഫ്ലോസീൻ ഗ്ലൈസമിക് എഫക്റ്റ്സ് (8.8% മുതൽ 7.9% വരെ HbA1c) കുറച്ചുമാത്രമേ നിശബ്ദരാണെന്നും നഥാൻ ചൂണ്ടിക്കാട്ടുന്നു. പുതിയ ഡയബറ്റിസ് മരുന്നുകളുടെ അംഗീകാരത്തിനായി സാധാരണ കുറഞ്ഞ FDA ആവശ്യങ്ങൾ തൃപ്തിപ്പെടുത്താൻ ഇത് പര്യാപ്തമല്ല.
"ഈ മരുന്നുകൾ കൂടുതൽ അനുയോജ്യമായി പ്രമേഹരോഗികൾക്കുള്ള ഹൃദയധമനികളുടെ ചികിത്സയ്ക്കായി പരിശോധിക്കേണ്ടതുണ്ട്, ഓരോ ഗ്ലൂക്കോസ്-താഴ്ത്തുന്ന മരുന്നുകൾക്കുമപ്പുറം, പരിഗണിക്കേണ്ട ആവശ്യമില്ലാത്ത സൂക്ഷ്മ വ്യതിയാനമാണ്," അദ്ദേഹം പറഞ്ഞു.
DECLARE-TIMI 58 ഫണ്ടായ Astra Zeneca, Bristol-Myers Squibb. Astra Zeneca, Bristol-Myers Squibb എന്നിവയിൽ നിന്നും വ്യക്തിഗത ഫീസ് നൽകും. ബസ്ലർ അസ്ത്ര സെനകയുടെ ഒരു കൺസൾട്ടന്റ് ആണ്.
അമേരിക്കൻ ഹാർട്ട് അസോസിയേഷൻ (AHA) സയന്റിഫിക് സെഷനുകൾ 2018. സംക്ഷിപ്തം നം. 19485. 2018 നവംബർ 10 ന് അവതരിപ്പിച്ചു.
എൻ എൻ ജി എൽ ജെ മെഡ്. ഓൺലൈനിൽ പ്രസിദ്ധീകരിച്ച നവംബർ 10, 2018. മുഴുവൻ പാഠവും
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