Dr Javed Butler Discusses the Possibility of HFpEF Combination Treatment

Treatment for heart failure with preserved ejection fraction (HFpEF) may soon resemble that for heart failure with reduced ejection fraction (HFrEF), with empagliflozin and mineralocorticoid receptor antagonists (MRA) showing promise, noted Javed Butler, MD, MPH, MBA, chairman for the Department of Medicine at the University of Mississippi.

Transcript

What are your thoughts on a combination regimen for HFpEF that contains empagliflozin or an SGLT2 inhibitor as the anchor drug?

I completely agree with that mindset. That mindset we had, and we were successful in HFrEF, so nobody questioned what is the drug for HFrEF to give combination therapy. And if you now look at this, we now have data with empagliflozin for EF [ejection fraction] all the way up to 65%. We'll see what happens above 65% soon, but we know that valsartan/sacubitril with median EF of less than 57% showed benefit. If you exclude the Russia/Georgia data from TOPCAT and all the heterogeneity that we saw, MRA seems to be benefiting as well. And now, obviously, we have HFpEF trials going on with MRA.

I would say that the HFpEF treatment, or at least a segment of HFpEF treatment, will start looking very much like HFrEF. But certainly, with EMPEROR-Preserved, empagliflozin all the way up to 65% is pretty much a straightforward answer.