Acta cardiologica · 2025
Role SGLT2 inhibitor therapy in patients with transthyretin cardiac amyloidosis: a GRADE assessed systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
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Khan Ahmed Ali, Faheem Muhammad Shaheer Bin, Wahid Fatima, Zulfiqar Kalsoom, Habib Hajra, Nawaz Maheen, Afridi Araiz, Tariq Salman, Humayoon Muhammad
Аннотация
BACKGROUND: Transthyretin amyloid cardiomyopathy (ATTR-CM) patients continue to experience worsening heart failure despite therapy with disease modifying therapies (tafamidis, patisiran, etc.). Given the proven benefits of SGLT2 inhibitors in heart failure, their efficacy in ATTR-CM patients remains unexplored.
METHODS: A systematic search of PubMed, Google Scholar, Web of Science, and Cochrane Central Library was conducted from inception to April 2025 for studies evaluating the efficacy of SGLT2 inhibitors in ATTR-CM patients receiving disease-modifying therapy. A random-effects meta-analysis model was used, and all-cause mortality was analysed as the primary outcome.
RESULTS: Seven observational studies comprising 7283 patients with transthyretin amyloidosis (ATTR) cardiomyopathy were included. SGLT2 inhibitors were associated with lower risk of all-cause mortality (RR: 0.51 [0.45, 0.57] 95% CI, p < 0.00001; I2 = 10%), cardiovascular mortality (RR: 0.30 [0.16, 0.55] 95% CI; p = 0.0001; I2 = 25%) and MACE (RR: 0.69 [0.59, 0.81] 95% CI; p < 0.00001; I2 = 10%) as compared to patients receiving no SGLT2 inhibitor. Additionally, the use of SGLT2 inhibitors was associated with significantly improved glomerular filtration rates (MD: 3.11 [0.52, 5.71] 95% CI, p = 0.02; I2 = 54%) as compared to patients receiving no SGLT2 inhibitor. SGLT2 inhibitor therapy did not have a significant effect on the risk of hospitalisations due to heart failure.
CONCLUSIONS: SGLT2 inhibitors, when used alongside disease-modifying agents, appear to improve survival and renal outcomes in patients with ATTR-CM. However, these findings are derived from observational studies with their inherent biases and must be interpreted with caution. High-quality randomised controlled trials are needed to confirm these associations and better define their clinical role in ATTR-CM.
METHODS: A systematic search of PubMed, Google Scholar, Web of Science, and Cochrane Central Library was conducted from inception to April 2025 for studies evaluating the efficacy of SGLT2 inhibitors in ATTR-CM patients receiving disease-modifying therapy. A random-effects meta-analysis model was used, and all-cause mortality was analysed as the primary outcome.
RESULTS: Seven observational studies comprising 7283 patients with transthyretin amyloidosis (ATTR) cardiomyopathy were included. SGLT2 inhibitors were associated with lower risk of all-cause mortality (RR: 0.51 [0.45, 0.57] 95% CI, p < 0.00001; I2 = 10%), cardiovascular mortality (RR: 0.30 [0.16, 0.55] 95% CI; p = 0.0001; I2 = 25%) and MACE (RR: 0.69 [0.59, 0.81] 95% CI; p < 0.00001; I2 = 10%) as compared to patients receiving no SGLT2 inhibitor. Additionally, the use of SGLT2 inhibitors was associated with significantly improved glomerular filtration rates (MD: 3.11 [0.52, 5.71] 95% CI, p = 0.02; I2 = 54%) as compared to patients receiving no SGLT2 inhibitor. SGLT2 inhibitor therapy did not have a significant effect on the risk of hospitalisations due to heart failure.
CONCLUSIONS: SGLT2 inhibitors, when used alongside disease-modifying agents, appear to improve survival and renal outcomes in patients with ATTR-CM. However, these findings are derived from observational studies with their inherent biases and must be interpreted with caution. High-quality randomised controlled trials are needed to confirm these associations and better define their clinical role in ATTR-CM.