@article{7f8753db41e34cbbbb482e0e17d08a1f,
title = "Efficacy of Dapagliflozin by Baseline Diabetes Medications: A Prespecified Analysis From the DAPA-CKD Study",
abstract = "OBJECTIVE To determine whether the benefits of dapagliflozin in patients with type 2 diabetes and chronic kidney disease (CKD) in the Dapagliflozin And Prevention of Adverse Outcomes in CKD trial (DAPA-CKD) varied by background glucose-lowering therapy (GLT). RESEARCH DESIGN AND METHODS We randomized 4,304 adults (including 2,906 with type 2 diabetes) with a baseline estimated glomerular filtration rate (eGFR) 25–75 mL/min/1.73 m2 and uri-nary albumin-to-creatinine ratio of 200–5,000 mg/g to dapagliflozin 10 mg or placebo once daily (NCT03036150). The primary end point was a composite of ‡50% eGFR decline, end-stage kidney disease, and kidney or cardiovascular cause of death. Secondary end points included a kidney composite end point (primary composite end point without cardiovascular death), a cardiovascular composite end point (hospitalized heart failure or cardiovascular death), and all-cause mor-tality. In this prespecified analysis, we investigated the effects of dapagliflozin on these and other outcomes according to baseline GLT class or number of GLTs. RESULTS The effects of dapagliflozin on the primary composite outcome were consistent across GLT classes and according to the number of GLTs (all interaction P > 0.08). Similarly, we found consistent benefit of dapagliflozin compared with placebo on the secondary end points regardless of background GLT class or number of GLTs. The same applied to the rate of decline in the eGFR rate and safety end points. Dapagliflozin reduced the initiation of insulin therapy during follow-up compared with placebo (hazard ratio 0.72; 95% CI 0.54–0.96; P = 0.025). CONCLUSIONS Dapagliflozin reduced kidney and cardiovascular events in patients with type 2 diabetes and CKD across baseline GLT class or classes in combination.",
author = "Beernink, {Jelle M.} and Frederik Persson and Niels Jongs and Laverman, {Gozewijn D.} and Chertow, {Glenn M.} and McMurray, {John J.V.} and Langkilde, {Anna Maria} and Ricardo Correa-Rotter and Peter Rossing and Sj{\"o}str{\"o}m, {C. David} and Toto, {Robert D.} and Wheeler, {David C.} and Heerspink, {Hiddo J.L.}",
note = "Funding Information: Acknowledgments. The authors acknowledge Nicola Truss (inScience Communications, London, U.K.) for assistance with the editing of the draft report and preparation of the figures (support funded by AstraZeneca). The authors thank all investigators, trial teams, and patients for their participation in the trial. Funding. R.D.T. was supported in part by the endowments from the Mary M. Conroy Professorship and the Houston J. and Florence A. Doswell Center for the Development of New Approaches for the Treatment of Hypertension. G.M.C. has received research grants from National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, National Heart, Lung, and Blood Institute, and National Institute of Allergy and Infectious Diseases. Duality of Interest. The trial was funded by AstraZeneca. F.P. has served as a consultant, on advisory boards, or as educator for AstraZeneca, Novo Nordisk, Boehringer Ingelheim, Sanofi, Mundipharma, Merck Sharpe & Dohme, Novar-tis, and Amgen, and has received research grants to the institution from Novo Nordisk, Boehringer Ingelheim, Amgen, and AstraZeneca. G.D.L. has received lecture fees from Sanofi, As-traZeneca, and Janssen, and has served as a consultant for AbbVie, Sanofi, Novo Nordisk, AstraZeneca, Boehringer Ingelheim, and Merck Sharp & Dohme. G.M.C. has received fees from AstraZeneca for service on the DAPA-CKD trial steering committee, serves on the board of directors for Satellite Healthcare, has served on other trial steering committees for Akebia, AstraZeneca, Gilead, Sanifit, and Vertex, and on data safety monitoring boards for Angion, Bayer, Mineralys, and ReCor, and has served as an advisor and received fees and/or stock options from Ardelyx, CloudCath, Cricket, DiaMedica, Durect, DxNow, Miromatrix, Outset, Physiowave, and Unicycive. J.J.V.M. has received payments to his employer, Glasgow University, for his work on clinical trials, consulting, and other activities from AstraZeneca, Cytokinetics, KBP Biosciences, Amgen, Bayer, Theracos, Ionis Pharmaceuticals, Dalcor Pharmaceuticals, Novartis, GlaxoSmithKline, Bristol- Publisher Copyright: {\textcopyright} 2023, American Diabetes Association Inc.. All rights reserved.",
year = "2023",
month = mar,
doi = "10.2337/dc22-1514",
language = "English (US)",
volume = "46",
pages = "602--607",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "3",
}