Dr Christopher Cannon on Dual SGLT1/2 Inhibitors

Christopher P. Cannon, MD, was one of the investigators on the SOLOIST trial, which led to the approval of sotagliflozin, the first dual sodium-glucose cotransporter-1 and -2 (SGLT1/2) inhibitor. Cannon, a professor of medicine at Harvard Medical School and senior physician in the Cardiovascular Division at Brigham and Women’s Hospital, spoke about the benefit seen in the study for patients with acute heart failure.

Transcript

What is the extra benefit of the dual mechanism in the combined SGLT1/2 inhibitor? And what type of patient do you think would benefit the most and what type of patient would not gain any benefit from it?

Well, I think we don’t know, mechanistically, if this patient needs the dual vs the single. I think in clinical care, we always come back to the large clinical trials that had clinical benefit, and then try and use therapies in those type settings. And so for sotagliflozin in the SOLOIST trial, it was the first and largest of them to date, I think—although moderate size—to test this class in patients who had just had an acute heart failure exacerbation or worsening heart failure, and had a huge benefit.

So the number of patients you need to treat to prevent 1 from dying or being rehospitalized is 4, for 9 months, which is unheard of in terms of a benefit. Typically, you know, therapies are 30, 50, 100 patients to treat, to prevent 1 event. The absolute benefit seen in that acute heart failure setting is probably the first place that many of us will turn to use this to try and emulate what was seen in the in the SOLOIST trial. There are data with the other agents in smaller studies suggesting similar type benefits, but not sort of the magnitude that was seen so clearly in the SOLOIST trial overall.