Dr Deepak L. Bhatt on Increasing the Use of SGLT2 Inhibitors in Clinical Practice

There are incredible data for sodium-glucose co-transporter 2 (SGLT2) inhibitors, and this is a great class of medicines that is vastly underutilized. With the positive trials we have, it's time to prescribe drugs from this class, stated Deepak L. Bhatt, MD, MPH, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital Heart & Vascular Center and professor of medicine at Harvard Medical School.

Bhatt's presentation "Benefits of SGLT2-1/2 Inhibition on Heart Failure, Ischemic, and Kidney Endpoints," will be available on-demand during ESC Congress 2021, this year's virtual meeting of the European Society of Cardiology.

Transcript

What can be done for more providers to prescribe SGLT2 inhibitors, and what can payers do?

We're sort of at the stage with SGLT2 inhibitors as a class where we were with statins maybe a decade ago—where there were enough positive trials that if you're sitting on the sidelines being a skeptic, well, then you're just one of those science deniers. I mean, the data for SGLT2 inhibitors are incredibly good.

Yes, there's the occasional patient that might get DKA [diabetic ketoacidosis]. Yes, you've got to be on the lookout for those sort of things, especially in patients with diabetes vs no diabetes, especially if they're on insulin, etc. Like every drug, you have to know how to use it.

Putting aside that typical practicing medicine type of common sense, this is a great class of medicines. It's vastly underutilized. Yes, some of that has to do with cost issues, but some of it's also just lack of knowledge of the data by physicians, some of it’s the typical clinical inertia that kicks in, some of it’s, “Oh, I need to see another trial before I get on board,” sort of thing.

But at this point, there are enough positive trials. It's time to find the appropriate patients and prescribe drugs from this class. And I'd say whichever one’s on the formulary, use that one. Don't worry so much about some of the issues even we discussed about which SGLT2 inhibitor is better. Certainly any is better than none.

So I would say, the implementation science is really big. And in terms of what third-party payers can do, some of the barrier to the uptake of SGLT2 inhibitors has just been the high co-pays that are quite common. And I think in patients with heart failure, I believe across the full range of ejection fraction, we proved in SOLOIST and SCORED that starting sotagliflozin was safe, with careful monitoring and clinical judgement and that sort of thing. But it was safe and was highly effective with large absolute risk reductions.

I'm more interested in the clinical aspects, but with large economic consequences, too, by preventing a lot of hospitalizations for heart failure, including that 30-day early window, get penalized if it happens in terms of hospital penalties and so forth. So I think it makes a lot of sense beyond just to do the right thing for the patient, just for the hospital and health care system to prevent those avoidable admissions and reduce health care costs to an extent by doing that. But that only works if the third-party payer is going to allow the SGLT2 inhibitor to be started in the hospital.