In Patients with Heart Failure Who Take SGLT-2 Inhibitors: Do Mineralocorticoid Receptor Antagonists Alter Effectiveness?

Sodium–glucose cotransporter-2 (SGLT-2) inhibitors have emerged as efficacious therapies that decrease adverse outcomes in patients with heart failure and reduced ejection fraction (HFrEF), adding to an already crowded field of therapies. In a secondary analysis of the manufacturer-supported EMPEROR-Reduced trial (NEJM JW Cardiol Oct 2020 and N Engl J Med 2020; 383:1413), researchers assessed whether baseline use of mineralocorticoid receptor antagonists (MRAs; i.e., spironolactone or eplerenone) modified the effectiveness of empagliflozin in patients with HFrEF and whether initiation of an SGLT-2 inhibitor influenced the later prescription of MRAs.

Of the 3730 individuals with HFrEF, 71% were receiving an MRA at randomization. After adjustm…