When the European Society of Cardiology kicked off its annual congress on Friday morning with new guidelines for diagnosing and treating heart failure, one of the more interested parties was AstraZeneca.
The company got the positive news it expected as the ESC endorsed its blockbuster treatment Farxiga. The ESC update solidifies the role of sodium-glucose cotransporter-2 (SGLT2) inhibitors as first-line treatments for heart failure patients with reduced ejection fraction (HFrEF).
“It’s very exciting because it means that together with three other classes, SGLT2s are now considered as essential treatments for heart failure,” Joris Silon, AZ’s chief of cardiovascular, renal and metabolism, said in an interview with Fierce Pharma. “In 2020, we were the first to come out with heart failure data for this class of drugs. We’ve been leading the charge.”
First designed to treat Type 2 diabetes, SGLT2s quickly proved in trials to also have cardiovascular benefits. So after Farxiga gained its initial approval in 2014 for Type 2 diabetes, it pursued other therapy areas. Last year, it was endorsed for patients with heart failure, regardless of whether they had Type 2 diabetes. In April of this year, it added an indication for chronic kidney disease (CKD), again for those with or without diabetes.
Farxiga is no longer the lone SGLT2 sanctioned for heart failure patients, though. Eli Lilly and Boehringer Ingelheim's Jardiance won approval for those with reduced ejection fraction just last month, and at ESC presented data in patients with preserved ejection fraction, too.
For its part, AZ presented eight abstracts at ESC for chronic kidney disease and heart failure. Of particular note are results that demonstrate Farxiga's kidney benefits in patients with and without heart failure.
“It’s just an additional point that shows that our effect in protecting the kidney is really independent of any comorbidities,” Silon said. “It’s exciting for physicians to be able to prescribe Farxiga in a very broad range of patients.”
Farxiga rang up $1.96 billion in sales last year and is looking to add even more indications. The next frontier for the drug will be heart failure with preserved ejection fraction, Silon said. Trials also are underway for acute heart failure and for prevention of heart failure in patients who have had a heart attack.
“It’s such a fantastic molecule that we really have to explore all angles so patients can benefit from it,” Silon said.
Also on Friday, AZ showed in a real-world observational trial of 7,000 participants that its clot-fighter Brilinta produced low bleeding rates and in the long term protected those who have had a heart attack.
The new ESC heart failure guidelines also recommend another AZ treatment, Lokelma, for hyperkalemia, a condition that results from raised potassium levels in the blood and is associated with heart failure and chronic kidney disease.