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Comment & Response
December 13, 2016

Lack of Benefit for Liraglutide in Heart Failure—Reply

Author Affiliations
  • 1Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 2Duke Clinical Research Institute, Durham, North Carolina
JAMA. 2016;316(22):2429-2430. doi:10.1001/jama.2016.15394

In Reply As highlighted by Mr Carbone and colleagues, comparing the FIGHT study with other recent trials of GLP-1 agonists raises interesting questions about how heart failure severity might affect GLP-1 response. Although the FIGHT study enrolled few patients with NYHA IV functional capacity (29% NYHA II, 63% NYHA III, and 5% NYHA IV), the patients enrolled clearly had more advanced heart failure (late American Heart Association/American College of Cardiology [AHA/ACC] stage C) than those in the LEADER study1 (mostly AHA/ACC stage A and B) or the Evaluation of Lixisenatide in Acute Coronary Syndrome (ELIXA) trial,2 which enrolled patients with a recent acute coronary event (early AHA/ACC stage C). There are many important distinctions among these and other recent trials of GLP-1 agonists for patients with type 2 diabetes.3 Nevertheless, the overall signal that seems to emerge is a reduction in cardiovascular outcomes among patients at risk for structural heart disease, a lack of effect on heart failure outcomes among those with early cardiac remodeling, and possible detrimental effects on heart failure outcomes in patients with advanced symptomatic heart failure.

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