There is an increasing prevalence and incidence of CKD globally and locally, and among the top causes of renal failure in Filipinos is diabetic nephropathy. 1-3
The 2022 ADA Standards of Care recommends SGLT2i or GLP-1 RA for DKD patients with or without albuminuria. Dapagliflozin has shown primary evidence in reducing CKD progression and has been shown to reduce CKD progression in CVOTs. 4
The DECLARE trial investigated the cardiorenal effect of dapagliflozin and has shown that dapagliflozin (FORXIGA) has demonstrated significant relative risk reduction of up to 47% in the occurrence of eGFR decrease of ≥40%, ESRD, and renal death. 5
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Figure 1. Kaplan-Meier curves for the composite renal-specific outcome 5
The composite renal-specific outcome consisted of a sustained decrease in eGFR by at least 40% to less than 60 mL/min per 1·73 m 2
, end-stage renal disease, or renal death. 5
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| The DAPA-CKD trial, a dedicated renal outcomes trial that assessed the efficacy and safety of SGLT2i for CKD, has also demonstrated that dapagliflozin (FORXIGA) reduces the risk of declining kidney function, ESKD, and renal or cardiovascular death. 5
Dapagliflozin (FORXIGA) has also been shown to provide significant benefit in preventing both the regression and progression in albuminuria in patients with T2D and CKD. 6
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Figure 2. DAPA-CKD composite endpoint in patients with type 2 diabetes: declining kidney function, end-stage kidney disease, and renal or cardiovascular death 6
In participants with type 2 diabetes, the hazard ratio for the comparison of dapagliflozin and placebo for the primary outcome was 0.64 (95% CI, 0.52 to 0.79), as compared with 0.50 (95% CI, 0.35 to 0.72) in participants without type 2 diabetes. 6
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| Abbreviations:
ADA=American Diabetes Association; CKD=chronic kidney disease; CVOTs=cardiovascular outcome trials; DAPA-CKD=Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease; DECLARE=Dapagliflozin Effect on Cardiovascular Events; DKD=diabetic kidney disease; ESKD=end-stage kidney disease; ESRD=end-stage renal disease; GLP-1 RA=glucagon-like peptide-1 receptor agonist; SGLT2i=sodium-glucose cotransporter-2 inhibitor; T2D=type 2 diabetes.
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| References:
1. Jager KJ, et al. Nephrol Dial Transplant.
2019;34:1803-1805. 2. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Lancet.
2018;392:1789-1858. 3. Hill NR, et al. PLoS One.
2016;11:e0158765. 4. American Diabetes Association. Diabetes Care.
2022;45(suppl 1):S175-S184. 5. Mosenzon O, et al. Lancet Diabetes Endocrinol.
2019 Aug;7(8):606-617. 6. Heerspink HJL, et al. N Engl J Med.
2020; 383:1436-1446. 7. Jongs N, et al. Presented at: ERA EDTA Congress; June 5-8, 2021; Virtual.
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Tel no.: +632 8777 8700 • www.astrazeneca.com.ph
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PH_DIABETES_PH-7113_05/13/2023
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