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Brief Report

DTT 2024; 3(2): 177-184

Published online September 30, 2024

https://doi.org/10.58502/DTT.24.0001

Copyright © The Pharmaceutical Society of Korea.

Preventing Heart Failure Admission with Sodium-Glucose Cotransporter-2 Inhibitors versus Angiotensin Receptor-Neprilysin Inhibitor: A Target Trial Emulation Study

Sohee Park1* , Sungho Bea1* , Yunha Noh1,2 , Gregory Y. H. Lip3,4 , Seng Chan You5 , Eue-Keun Choi6,7 , Han Eol Jeong1,8 , Ju-Young Shin1,8,9

1School of Pharmacy, Sungkyunkwan University, Suwon, Korea
2Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
3Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
4Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
5Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
6Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
7Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
8Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, Korea
9Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea

Correspondence to:Han Eol Jeong, haneoljeong@hotmail.com; Ju-Young Shin, shin.jy@skku.edu
*These authors contributed equally to this work.
Sohee Park’s current affiliation: Aston Pharmacy School, Aston University, Birmingham, United Kingdom
Sungho Bea’s current affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

Received: January 23, 2024; Revised: May 10, 2024; Accepted: August 14, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Little is known on the real-world comparative effectiveness of sodium-glucose cotransporter-2 inhibitors (SGLT2i) versus angiotensin receptor-neprilysin inhibitor (ARNi) used for heart failure (HF) management. This study used South Korea’s nationwide claims data from 2015 to 2020 to construct a population-based cohort of new users of SGLT2is or ARNi. Individuals were followed from the first prescription date of SGLT2is or ARNi until outcome occurrence, treatment switch or discontinuation, death, or end of the study period. Within the 1:1 propensity score-matched cohort, we estimated hazard ratios (HR) with 95% confidence intervals (CI) for the risk of HF admission with SGLT2is compared with ARNi using proportional subdistribution hazards model of Fine and Gray. We identified 496 propensity-score matched patient-pairs of SGLT2is and ARNi; with a mean age of 72.5 years and a male representation of 57.6%. Incidence rate of HF admission was 27.3 and 35.6 per 100 person-years in SGLT2is and ARNi group. When comparing the risk of HF admission associated with SGLT2is group with ARNi group, HR was 0.71 (95% CI 0.48-1.04). Effect modifications were observed by history of hospitalization for HF (p-for-interaction=0.002) and by recent use of renin-angiotensin-system inhibitors (p-for-interaction= 0.005). With future studies using more recent data warranted to corroborate our study results, these preliminary findings support current guideline recommendations for HF management and further, suggest similar effectiveness between SGLT2is and ARNi in routine care settings.

KeywordsSGLT2i, ARNi, heart failure, target trial emulation, real-world evidence

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