{"id":"b68d8e419204","type":"article","url":"https://hartvaat.nl/2026/10/01/sglt2-remmers-geassocieerd-met-lagere-sterfte-bij-attr-cardiomyopathie-meta-anal/","title":"SGLT2-remmers geassocieerd met lagere sterfte bij ATTR-cardiomyopathie — meta-analyse","title_en":"Efficacy and tolerability of sodium-glucose cotransporter-2 inhibitors in transthyretin amyloid cardiomyopathy: A systematic review and stratified meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"Current problems in cardiology","doi":"10.1016/j.cpcardiol.2026.103409","source_url":"https://doi.org/10.1016/j.cpcardiol.2026.103409","authors":["Roberta Magnano","Davide Rossi","Silvio Saraullo","Vittoria Zuardi","Laura Pezzi","Alberto D'Alleva","Mario Di Marino","Claudio Scollo","Eugenio Genovesi","Stefano Guarracini","Daniele Forlani","Piergiusto Vitulli","Giulia Renda","Sabina Gallina","Massimo Di Marco"],"significance":5,"published":"2026-08-21","source_date":"2026-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"A systematic review and stratified meta-analysis of 18 observational studies (n≈24,000) indicates that SGLT2 inhibitors are associated with reduced all-cause mortality in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) (HR 0.65; 95% CI 0.56–0.76). Benefits were also observed for composite mortality and heart failure events, with a favorable safety profile and low discontinuation rates. However, the evidence remains limited by the observational design, endpoint heterogeneity, and potential database overlap. While promising for cardiologists and internists managing this rare cardiomyopathy, dedicated randomized trials are required before SGLT2 inhibitors can be routinely recommended in this population.","created":"2026-08-15T00:57:34Z","updated":"2026-08-15T00:57:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een systematische review en meta-analyse van 18 cohortstudies (n≈24.000) toont aan dat SGLT2-remmers bij patiënten met transthyretine-amyloïdose cardiomyopathie (ATTR-CM) geassocieerd zijn met een lagere all-cause sterfte (HR 0,65; 95%-BI 0,56-0,76). Hoewel hartfalen-gerelateerde uitkomsten en een samengestelde endpoint van sterfte of HF-episodes eveneens gunstig uitvielen, benadrukken de auteurs dat de bewijsvoering beperkt blijft door de observatieopzet, heterogeniteit en mogelijke database-overlap. Voor cardiologen en internisten biedt dit een aanwijzing dat SGLT2-remmers veilig en effectief kunnen zijn in deze zeldzame hartfalenpopulatie, maar bevestiging door gerandomiseerde trials is noodzakelijk voordat routine toepassing kan worden geadviseerd.","abstract_original":"AIMS: Although disease-modifying therapies have changed the management of transthyretin amyloid cardiomyopathy (ATTR-CM), supportive heart failure care remains crucial. Patients with ATTR-CM were excluded or underrepresented in randomized trials of sodium-glucose cotransporter-2 inhibitors (SGLT2i), leaving their role in this population uncertain. We performed a systematic review and stratified meta-analysis evaluating their efficacy, safety, and tolerability. METHODS AND RESULTS: PubMed/MEDLINE, Scopus, and the Cochrane Library/CENTRAL were searched up to 1 May 2026. The primary endpoint was ATTR-specific HR-based all-cause mortality. For studies enrolling both ATTR and AL amyloidosis, only separable ATTR subcohort estimates were extracted for the primary synthesis; AL estimates were excluded. Risk of bias was assessed using ROBINS-I and certainty of evidence using GRADE. Eighteen studies were included, comprising 12,039 SGLT2i-treated patients and 12,016 comparator patients across all analytic domains, although possible database overlap should be considered. The primary ATTR-specific HR-based synthesis showed an association between SGLT2i therapy and lower all-cause mortality (HR 0.65, 95% CI 0.56-0.76; I²=37.5%; 8 studies). HF-related events were directionally favourable but non-definitive (HR 0.73, 95% CI 0.50-1.06; I²=73.2%; 5 studies). Composite mortality/HF-related outcomes were associated with a lower risk (HR 0.69, 95% CI 0.55-0.85; I²=3.1%; 3 studies). Arrhythmic outcomes were only exploratory. SGLT2i therapy appeared well tolerated, with low pooled rates of definite discontinuation (6.9%), genitourinary events (4.7%), and AKI/renal adverse events (2.3%). CONCLUSION: Current non-randomized ATTR-specific evidence suggests that SGLT2i therapy in ATTR-CM/ATTR-HF is associated with lower all-cause mortality and acceptable safety and tolerability. Certainty remains low because of observational design, endpoint heterogeneity, heterogeneous background disease-modifying therapy, potential database overlap, and lack of patient-level amyloidosis subtype/stage stratification. Dedicated randomized trials are needed."}