Semaglutide in Patients with Heart Failure with Preserved Ejection Fraction and Obesity.
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
21 Sep 2023
21 Sep 2023
Historique:
medline:
22
9
2023
pubmed:
25
8
2023
entrez:
25
8
2023
Statut:
ppublish
Résumé
Heart failure with preserved ejection fraction is increasing in prevalence and is associated with a high symptom burden and functional impairment, especially in persons with obesity. No therapies have been approved to target obesity-related heart failure with preserved ejection fraction. We randomly assigned 529 patients who had heart failure with preserved ejection fraction and a body-mass index (the weight in kilograms divided by the square of the height in meters) of 30 or higher to receive once-weekly semaglutide (2.4 mg) or placebo for 52 weeks. The dual primary end points were the change from baseline in the Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS; scores range from 0 to 100, with higher scores indicating fewer symptoms and physical limitations) and the change in body weight. Confirmatory secondary end points included the change in the 6-minute walk distance; a hierarchical composite end point that included death, heart failure events, and differences in the change in the KCCQ-CSS and 6-minute walk distance; and the change in the C-reactive protein (CRP) level. The mean change in the KCCQ-CSS was 16.6 points with semaglutide and 8.7 points with placebo (estimated difference, 7.8 points; 95% confidence interval [CI], 4.8 to 10.9; P<0.001), and the mean percentage change in body weight was -13.3% with semaglutide and -2.6% with placebo (estimated difference, -10.7 percentage points; 95% CI, -11.9 to -9.4; P<0.001). The mean change in the 6-minute walk distance was 21.5 m with semaglutide and 1.2 m with placebo (estimated difference, 20.3 m; 95% CI, 8.6 to 32.1; P<0.001). In the analysis of the hierarchical composite end point, semaglutide produced more wins than placebo (win ratio, 1.72; 95% CI, 1.37 to 2.15; P<0.001). The mean percentage change in the CRP level was -43.5% with semaglutide and -7.3% with placebo (estimated treatment ratio, 0.61; 95% CI, 0.51 to 0.72; P<0.001). Serious adverse events were reported in 35 participants (13.3%) in the semaglutide group and 71 (26.7%) in the placebo group. In patients with heart failure with preserved ejection fraction and obesity, treatment with semaglutide (2.4 mg) led to larger reductions in symptoms and physical limitations, greater improvements in exercise function, and greater weight loss than placebo. (Funded by Novo Nordisk; STEP-HFpEF ClinicalTrials.gov number, NCT04788511.).
Sections du résumé
BACKGROUND
BACKGROUND
Heart failure with preserved ejection fraction is increasing in prevalence and is associated with a high symptom burden and functional impairment, especially in persons with obesity. No therapies have been approved to target obesity-related heart failure with preserved ejection fraction.
METHODS
METHODS
We randomly assigned 529 patients who had heart failure with preserved ejection fraction and a body-mass index (the weight in kilograms divided by the square of the height in meters) of 30 or higher to receive once-weekly semaglutide (2.4 mg) or placebo for 52 weeks. The dual primary end points were the change from baseline in the Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS; scores range from 0 to 100, with higher scores indicating fewer symptoms and physical limitations) and the change in body weight. Confirmatory secondary end points included the change in the 6-minute walk distance; a hierarchical composite end point that included death, heart failure events, and differences in the change in the KCCQ-CSS and 6-minute walk distance; and the change in the C-reactive protein (CRP) level.
RESULTS
RESULTS
The mean change in the KCCQ-CSS was 16.6 points with semaglutide and 8.7 points with placebo (estimated difference, 7.8 points; 95% confidence interval [CI], 4.8 to 10.9; P<0.001), and the mean percentage change in body weight was -13.3% with semaglutide and -2.6% with placebo (estimated difference, -10.7 percentage points; 95% CI, -11.9 to -9.4; P<0.001). The mean change in the 6-minute walk distance was 21.5 m with semaglutide and 1.2 m with placebo (estimated difference, 20.3 m; 95% CI, 8.6 to 32.1; P<0.001). In the analysis of the hierarchical composite end point, semaglutide produced more wins than placebo (win ratio, 1.72; 95% CI, 1.37 to 2.15; P<0.001). The mean percentage change in the CRP level was -43.5% with semaglutide and -7.3% with placebo (estimated treatment ratio, 0.61; 95% CI, 0.51 to 0.72; P<0.001). Serious adverse events were reported in 35 participants (13.3%) in the semaglutide group and 71 (26.7%) in the placebo group.
CONCLUSIONS
CONCLUSIONS
In patients with heart failure with preserved ejection fraction and obesity, treatment with semaglutide (2.4 mg) led to larger reductions in symptoms and physical limitations, greater improvements in exercise function, and greater weight loss than placebo. (Funded by Novo Nordisk; STEP-HFpEF ClinicalTrials.gov number, NCT04788511.).
Identifiants
pubmed: 37622681
doi: 10.1056/NEJMoa2306963
doi:
Substances chimiques
Glucagon-Like Peptides
62340-29-8
semaglutide
53AXN4NNHX
Banques de données
ClinicalTrials.gov
['NCT04788511']
Types de publication
Randomized Controlled Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1069-1084Investigateurs
Daniel Piskorz
(D)
Cesar Zaidman
(C)
Eduardo Perna
(E)
Sonia Hermida
(S)
Claudio Majul
(C)
Paula Perez Terns
(P)
John Amerena
(J)
Andrew Sindone
(A)
Melissa Leung
(M)
Walter Abhayaratna
(W)
Carmine de Pasquale
(C)
James Cha
(J)
Amritanshu-Shekhar Pandey
(AS)
Paul Poirier
(P)
Ram Vijayaraghavan
(R)
Louis Yao
(L)
Michael Heffernan
(M)
Yaariv Khaykin
(Y)
Daniel Rob
(D)
Jan Belohlavek
(J)
Vojtech Melenovsky
(V)
Zdenek Klimsa
(Z)
Jan Mácha
(J)
Ondrej Cermak
(O)
Christoph Axthelm
(C)
Karl-Friedrich Appel
(KF)
Holger Eggebrecht
(H)
Stefan Störk
(S)
Dennis Wolf
(D)
Frank Edelmann
(F)
Andreas Hagenow
(A)
Morten Schou
(M)
Kenneth Egstrup
(K)
Henrik Wiggers
(H)
Béla Merkely
(B)
Géza Lupkovics
(G)
Gergely Nagy
(G)
József Lippai
(J)
Tímea Tanczer
(T)
András Papp
(A)
László Könyves
(L)
Imre Szakál
(I)
Yaron Arbel
(Y)
Michael Shechter
(M)
Tuvia Ben-Gal
(T)
Rabea Asleh
(R)
Shaul Atar
(S)
Peter van der Meer
(P)
Anastazia Jerzewski
(A)
Amber Otten
(A)
Carlos da Fonseca
(C)
Jose Drost
(J)
Iris Westendorp
(I)
Senan Hammadi
(S)
Malgorzata Lelonek
(M)
Pawel Balsam
(P)
Krzysztof Cymerman
(K)
Anna Tomaszuk-Kazberuk
(A)
Danuta Wronska
(D)
Aleksander Zurakowski
(A)
Julio Núñez Villota
(J)
José González Juanatey
(J)
Santiago De Dios Pérez
(S)
Mark Petrie
(M)
Fozia Ahmed
(F)
Ross Campbell
(R)
Ify Mordi
(I)
Piers Clifford
(P)
Yuk-Ki Wong
(YK)
Paul Foley
(P)
Chih Wong
(C)
Prathap Kanagala
(P)
Lokesh Chandra
(L)
Suhail Khadra
(S)
Mikhail Kosiborod
(M)
Michael Pursley
(M)
Mohammad Tahir
(M)
Parag Goyal
(P)
Dalane Kitzman
(D)
Steven Lupovitch
(S)
Rita Jermyn
(R)
Joseph Thibodeau
(J)
Gregory Egnaczyk
(G)
Michael Fong
(M)
Tariq Haddad
(T)
Kavita Sharma
(K)
Vishnu Garla
(V)
Chen Chow
(C)
Bharat Kumar Gummadi
(BK)
Stuart Prenner
(S)
Ravi Patel
(R)
Sunit-Preet Chaudhry
(SP)
Steven Heatherly
(S)
Bruce Iteld
(B)
Keith Miller
(K)
Mubashir Qazi
(M)
William Eaves
(W)
Anil Chhabra
(A)
Ambarish Pandey
(A)
Subodh Verma
(S)
Melanie Davies
(M)
Barry Borlaug
(B)
Javed Butler
(J)
Sanjiv Shah
(S)
Novo Nordisk
(N)
Steen Abildstrøm
(S)
Marianne Bach Treppendahl
(M)
Kees Hovingh
(K)
Daniél Vega Møller
(D)
Dirk Von Lewinski
(D)
Justin Ezekowitz
(J)
Vijay Chopra
(V)
Michele Senni
(M)
Hiroshi Ito
(H)
Małgorzata Lelonek
(M)
Michael Fu
(M)
Informations de copyright
Copyright © 2023 Massachusetts Medical Society.