Creating Resonance- Patient-Centric Holistic Approaches in T2D Care dr. Aman.pptx

Creating Resonance:
Patient-Centric Holistic
Approaches in T2D Care
dr. Amanda Trixie Hardigaloeh, Sp.PD-
KEMD

Disclaimer
• The meeting and material are organized and sponsored by PT. AstraZeneca Indonesia.
• This is a promotional meeting.
• The speaker in this meeting receive honoraria from PT. AstraZeneca Indonesia.
• Pertemuan ilmiah dan materi dalam pertemuan ini diselenggarakan dan disponsori
oleh PT. AstraZeneca Indonesia.
• Pertemuan ilmiah ini adalah pertemuan yang bersifat promosi.
• Pembicara dalam pertemuan ilmiah ini menerima honoraria dari PT. AstraZeneca
Indonesia.

BMI, body mass index; OD, once daily; T2D, Type 2 diabetes
Meet our patient Mr. M
PATIENT
CHARACTERISTICS
Name:
Age:
BMI:
Smoker:
Mr. M
51 years old
22 kg/m2
No
T2D (diagnosed 7 years ago)
Medication
 Metformin 1500 mg OD
 Simvastatin 10 mg OD
MEDICAL HISTORY
Your Patient
Profile Lab results
GDMT Summary
Clinical scenarios
Hypothetical patient profile
1 2 3 4

BP, blood pressure; eGFR, estimated glomerular filtration rate; HbA1c, haemoglobin A1C; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; PCP, primary care
physician; UACR, urine albumin:creatinine ratio
PATIENT
CHARACTERISTICS
Name:
Age:
BMI:
Smoker:
Mr. M
51 years old
22 kg/m2
No
Your Patient
Profile Lab results
GDMT Summary
Clinical scenarios
1 2 3 4
 eGFR: 62 mL/min/1.73 m2
 UACR: N/A mg/g
 BP: 129/85 mmHg
LABORATORY RESULTS
 LDL-C: 140 mg/dL
 HDL-C: 40 mg/dL
 HbA1c: 140.1 mg/dL (6.5%)

BP, blood pressure; eGFR, estimated glomerular filtration rate; HbA1c, haemoglobin A1C; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; PCP, primary care
physician; UACR, urine albumin:creatinine ratio
PATIENT
CHARACTERISTICS
Name:
Age:
BMI:
Smoker:
Mr. M
51 years old
22 kg/m2
No
Your Patient
Profile Lab results
GDMT Summary
Clinical scenarios
1 2 3 4
 UACR: N/A mg/g
 BP: 129/85 mmHg
LABORATORY RESULTS
 HDL-C: 40 mg/dL
 HbA1c: 140.1 mg/dL (6.5%)
On a routine check-up for his T2D, Mr. M’s PCP noticed his eGFR is slightly reduced,
despite his diabetes being well controlled with metformin, diet and exercise.

BMI, body mass index; BP, blood pressure; eGFR, estimated glomerular filtration rate; HbA1c, haemoglobin A1C; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol;
PCP, primary care physician; UACR, urine albumin:creatinine ratio
3 months later, Mr. M’s eGFR has dropped
PATIENT
CHARACTERISTICS
Your Patient
Profile Lab results
GDMT Summary
Clinical scenarios
1 2 3 4
Name:
Age:
BMI:
Smoker:
Mr. M
51 years old
22 kg/m2
No
 UACR: 100 mg/g
 BP: 131/85 mmHg
LABORATORY RESULTS
 HDL-C: 35 mg/dL
 HbA1c: 140.1 mg/dL (6.5%)
Mr. M’s PCP notices his eGFR has
declined rapidly over the past
three months and also tests his
UACR at this point

a
Median (95% CI) eGFR change (mL/min/1.73 m2
per year). eGFR decline was estimated before and after CKD diagnosis by fitting individual linear regression models with time
to (and from) diagnosis in years as the only independent variable for the 2-year period before, and up to 2-year period after, CKD diagnosis. eGFR values from ±0.5 years
around the time of diagnosis were excluded to minimize the impact of regression to the mean observed around time zero; b
P-value comparing eGFR decline before and after
CKD diagnosis calculated using Wilcoxon’s rank sum test; c
Delayed diagnosis by increments of 1-year
CI, confidence interval; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; hHF, hospitalization for heart failure; MI, myocardial infarction
Tangri N, et al. Adv Ther 2023;40:2869–2885
eGFR decline before and after CKD diagnosis
(N=26,851)
60
55
50
45
−2 −1 0 1 2
Time from first CKD diagnosis (years)
Before CKD diagnosis After CKD diagnosis
eGFR
(mL/min/1.73
m
2
)
−3.20
(95% CI: −3.38, −3.00)a
P<0.001b
−0.74
(95% CI: −0.96, −0.53)a
P<0.001b
Diagnosis
Delayed CKD diagnosis was associated
with elevated risk of:c
40%
63%
CKD progression
To stage 4/5
Kidney failure
Transplant or chronic dialysis
Early screening and diagnosis is crucial
to improving your patients’ outcomes

BMI, body mass index; BP, blood pressure; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; HbA1c, haemoglobin A1C; HDL-C, high-density lipoprotein cholesterol;
LDL-C, low-density lipoprotein cholesterol; T2D, Type 2 diabetes; UACR, urine albumin:creatinine ratio
After a further 3 months, Mr. M’s PCP retests his eGFR and UACR
PATIENT
CHARACTERISTICS
 UACR: 122 mg/g
 BP: 128/83 mmHg
LABORATORY RESULTS
 HDL-C: 60 mg/dL
 HbA1c: 140.1 mg/dL 6.5%
Mr. M’s eGFR has continued to
decline since his previous visit
His UACR is also moderately increased
CKD diagnosis
Your Patient
Profile Lab results
GDMT Summary
Clinical scenarios
1 2 3 4
Name:
Age:
BMI:
Smoker:
Mr. M
51 years old
22 kg/m2
No

A1 A2 A3
Normal to
mildly
increased
Moderately
increased
Severely
increased
<30 mg/g
<3 mg/mmol
30–299 mg/g
3–29 mg/mmol
≥300 mg/g
≥30 mg/mmol
G1 Normal or high ≥90
G2 Mildly decreased 60–89
G3a
Mildly to moderately
decreased
45–59
G3b
Moderately to
severely decreased 30–44
G4 Severely deceased 15–29
G5 Kidney failure <15
Image adapted from de Boer IH, et al, 2022 a
If no other markers of kidney disease, no CKD
BMI, body mass index; BP, blood pressure; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; HbA1c, haemoglobin A1C; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-
density lipoprotein cholesterol; T2D, Type 2 diabetes; UACR, urine albumin:creatinine ratio
de Boer IH, et al. Diabetes Care 2022;45:3075–3090
The eGFR and UACR results confirm that Mr. M has Stage 3a CKD
CKD diagnosis
Persistent albuminuria categories
Description and range
Low riska
Mr. M
Moderately increased risk
High risk
Very high risk
PATIENT
CHARACTERISTICS
eGFR
categories
(mL/min/1.73
m
2
)
Description
and
range
Your Patient
Profile Lab results
GDMT Summary
Clinical scenarios
1 2 3 4
Name:
Age:
BMI:
Smoker:
Mr. M
51 years old
22 kg/m2
No
 UACR: 122 mg/g
 BP: 128/83 mmHg
LABORATORY RESULTS
 HDL-C: 35 mg/dL
 HbA1c: 140.1 mg/dL 6.5%

A1 A2 A3
Normal to
mildly
increased
Moderately
increased
Severely
increased
<30 mg/g
<3 mg/mmol
30–299 mg/g
3–29 mg/mmol
≥300 mg/g
≥30 mg/mmol
G1 Normal or high ≥90 Screen Treat
Treat and
refer
G2 Mildly decreased 60–89 Screen Treat Treat and
refer
G3a
Mildly to moderately
decreased
45–59 Treat Treat Treat and
refer
G3b
Moderately to
severely decreased
30–44 Treat
Treat and
refer
Treat and
refer
G4 Severely deceased 15–29 Treat and
refer
Treat and
refer
Treat and
refer
G5 Kidney failure <15 Treat and
refer
Treat and
refer
Treat and
refer
Image adapted from de Boer IH, et al, 20221 a
If no other markers of kidney disease, no CKD
BP, blood pressure; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; HbA1c, haemoglobin A1C; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein
cholesterol; T2D, Type 2 diabetes; UACR, urine albumin:creatinine ratio
1. de Boer IH, et al. Diabetes Care 2022;45:3075–3090; 2. Kidney Disease: Improving Global Outcomes. Kidney Int 2024;105:S117–S314
Mr. M should now be treated to prevent further decline
eGFR
categories
(mL/min/1.73
m
2
)
Description
and
range
Persistent albuminuria categories
Description and range
PATIENT
CHARACTERISTICS
Name:
Age:
BMI:
Smoker:
Mr. M
51 years old
22 kg/m2
No
 UACR: 122 mg/g
 BP: 128/83 mmHg
LABORATORY RESULTS
 HDL-C: 60 mg/dL
 HbA1c: 140.1 mg/dL 6.5%
Low riska
Moderately increased risk
High risk
Very high risk
Your Patient
Profile Lab results
GDMT Summary
Clinical scenarios
1 2 3 4
CKD diagnosis
KDIGO guidelines recommend that
patients with CKD stage 3a/A2 are
treated and are monitored twice a
year by primary care physicians1,2

a
± other markers of kidney damage. Markers of kidney damage other than albuminuria may also be used to diagnose CKD, but UACR and eGFR are still required to determine stage and
estimate risk of progression; b
Measure eGFRcr-cys if not performed and available
CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; KDIGO, Kidney Disease: Improving Global Outcomes; UACR, urine albumin:creatinine ratio
Kidney Disease: Improving Global Outcomes. Kidney Int 2024;105:S117–S314
Screening diagnosis and staging of CKD
Identify adults at risk for CKD
Stage CKD according to eGFR and UACRb
• Establish underlying cause
• Estimate risk of progression
Initiate treatment
Test for eGFR and UACRa
KDIGO guidelines recommend testing both
eGFR and UACR adults at risk of CKD
An eGFR <60 mL/min/1.73 m2
for
>3 months indicates a diagnosis of CKD
A UACR ≥30 mg/g for >3 months alone can
guide diagnosis, irrespective of eGFR
Adapted from KDIGO Guidelines 2024. Refer to guidelines for more information
Screening both eGFR and UACR can support an early diagnosis

ADA guidelines recommend a multifactorial approach
to reduce diabetes-related complications1
Glycemic
management
Blood pressure
management
Lipid
management
Agents with
cardiovascular and
kidney benefita
Reduction in diabetes complications
Lifestyle modification and diabetes education

KDIGO’s latest guidance now positions SGLT2 inhibitors as SoC in
the holistic management of patients with CKD across etiologies3
Refer to guidelines for full information
Lifestyle
First-line drug
therapy for
most patients
Targeted
therapies for
complications
Physical activity Stop use of
tobacco products
Weight
management
Regular risk
factor reassessment
(every 3–6 months)
Healthy diet
SGLT2i
Continue until
dialysis or
transplant
Aim for SBP <120 mmHg
RASia
at maximum
tolerated dose
(if HTN)
Statin-based therapy,
moderate- or
high-intensity statin
Manage hyperglycemia as per
the KDIGO diabetes guideline,
including use of GLP-1 RA
where indicated
Dihydropyridine CCB
and/or diuretic if
needed to achieve
individualized
BP target
Use ns-MRA in
people with diabetes
and an indication
for use
Antiplatelet agent
for clinical ASCVD
Manage anemia,
CKD-MBD, acidosis,
and potassium
abnormalities,
where indicated
Ezetimibe, PCSK9i,
indicated based on
ASCVD risk and lipids
Use the same principles to
diagnose and manage ASCVD
and atrial fibrillation as in
people without CKD
Steroidal MRA if
needed for resistant
HTN if eGFR ≥45
ASCVD risk, lipids
BP
+ First-line CKD
treatment for patients
with a range of
nephropathies
GDMT
SGLT2i
RASi
+
+
Statin-based
therapy
Disclaimer: In Indonesia, Forxiga is approved for CKD treatment with eGFR >30 mL/min/1.73m2

KDIGO recommends SGLT2 inhibitors for the
treatment of patients with CKD and T2D3
Recommendation 3.7.1
We recommend treating
patients with T2D, CKD, and
an eGFR ≥20 mL/min/1.73 m2
with an SGLT2 inhibitora,b,c
1A
CKD with T2D

Disclaimer: In indonesia, Forxiga is approved for CKD treatment in pateints with eGFR > 30 mL/min/1..73m2
a
Strength of recommendation indicated as Level 1 (recommended) or level 2 (suggested); certainty of evidence defined as A (high), B (moderate), or C (low)1
ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; GDMT, guideline-directed medical therapy; HF, heart
failure; OD, once daily; RASi, renin-angiotensin system inhibitor; SGLT2, sodium–glucose co-transporter 2; T2D, Type 2 diabetes; UACR, urine albumin:creatinine ratio
1. Kidney Disease: Improving Global Outcomes. Kidney Int 2024;105:S117–S314; 2. Forxiga Product Information Indonesia, April 2024
Initiation of an SGLT2 inhibitor like FORXIGA as part of
GDMT is recommended for patients like Mr. M
PATIENT
CHARACTERISTICS
 UACR: 122 mg/g
LABORATORY RESULTS Medication
 Metformin 1500 mg OD
 FORXIGA 10 mg OD
 CRESTOR 10 mg OD
 ACEi
KDIGO Class 1A Recommendation 3.7.11,a
SGLT2 inhibitors are recommended for
patients with T2D, CKD, and an eGFR
≥20 mL/min per 1.73 m2
KDIGO Class 1B Recommendation 3.6.31,a
RASi (ACEi or ARB) are also recommended for people with
CKD and moderately-to-severely increased albuminuria
(G1–G4, A2 and A3) with diabetes
Refer to individual SGLT2 inhibitor prescribing information for eGFR cut-off
points for initiation. Due to limited experience, it is not recommended to
initiate treatment with FORXIGA in patients with eGFR <25 mL/min/1.73 m2 2
Your Patient
Profile Lab results
GDMT Summary
Clinical scenarios
1 2 3 4
Name:
Age:
BMI:
Smoker:
Mr. M
51 years old
22 kg/m2
No

FORXIGA reduces the risk of the composite of declining kidney
function, ESKD, and renal or CV death
a
Primary composite endpoint of ≥50% sustained decline in eGFR, reaching ESKD and renal or CV death. ESKD defined as the need for maintenance dialysis (peritoneal or
haemodialysis) for at least 28 days and renal transplantation or sustained eGFR <15 mL/min/1.73 m2
for at least 28 days1
; b
SoC included maximum tolerated labelled dose
of an ACEi or ARB. Management of blood pressure, lipids and glucose, and the use of other essential therapies was left to the discretion of the investigator2
ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARR, absolute risk reduction; CI, confidence interval; CV, cardiovascular; eGFR, estimated glomerular filtration rate; ESKD, end-stage kidney disease; HR, hazard ratio; OD, once daily;
RRR, relative risk reduction; SGLT2, sodium–glucose co‑transporter 2; SoC, standard of care
1. Heerspink HJL, et al. N Engl J Med 2020;383:1436–1446; 2. Heerspink HJL, et al. Nephrol Dial Transplant 2020;35:274–282
DAPA-CKD primary composite endpoint1
(≥50% decline in eGFR, ESKD, and renal or CV deatha
)
Placebo + SoCb
(n=2152)
FORXIGA 10 mg OD + SoCb
(n=2152)
HR: 0.61 (95% CI: 0.51, 0.72)
P<0.001
Time from randomization (months)
Median follow-up of 2.4 years
Cumulative
incidence
(%)
24
0 4 8 12 16 20
0
4
8
12
16
24 28 32
20
5.3%
ARR
39RRR1
%
vs placebo
FORXIGA 2152 2001 1955 1898 1841 1701 1288 831 309
Placebo 2152 1993 1936 1858 1791 1664 1232 774 270
Number at risk

a
Primary composite endpoint of ≥50% sustained decline in eGFR, reaching ESKD, and renal or CV death. ESKD defined as the need for maintenance dialysis (peritoneal
or hemodialysis) for at least 28 days, and renal transplantation or sustained eGFR <15 mL/min/1.73 m2
for at least 28 days; b
DAPA-CKD exploratory subgroup analysis;
c
There was no significant interaction of the effect on the primary composite endpoint by diabetes status (P for interaction = 0.98)
ARR, absolute risk reduction; CV, cardiovascular; eGFR, estimated glomerular filtration rate; ESKD, end-stage kidney disease; RRR, relative risk reduction; T2D, Type 2 diabetes
Wheeler DC, et al. Lancet Diabetes Endocrinol 2021;9:22–31
DAPA-CKD composite endpoint: Declining kidney function,
ESKD, and renal or CV deatha,b,c
Patients without T2D
5.4%
ARR
50RRR
%
Patients with T2D
5.3%
ARR
36RRR
%
FORXIGA has consistent efficacy in patients with and
without T2D
vs placebo vs placebo

Starting Mr. M on an SGLT2 inhibitor can stabilize his eGFR
Image adapted from Heerspink HJL, et al, 2020
The bars within the graph indicate standard errors
a
Excludes the first 2 weeks of the study period (eGFR dip)
CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; OD, once daily; SGLT2, sodium-glucose co-transporter 2
1. Heerspink HJL, et al. N Engl J Med 2020;383:1436–1446; 2. Kidney Disease: Improving Global Outcomes. Kidney Int 2024;105:S118–S295
FORXIGA may induce a transient and reversible dip in eGFR; however, KDIGO
guidelines state this is not a reason to discontinue therapy2
eGFR stabilization with FORXIGA in DAPA-CKD1
Mean eGFR at baseline:
FORXIGA = 43.2 mL/min/1.73 m2
Placebo = 43.0 mL/min/1.73 m2
Placebo
FORXIGA 10 mg OD
0 4
2 28 36
8 12 16 20 24 32
−0
−3
−6
−9
−12
−15
Least
squares
mean
change
in
eGFR
(mL/min/1.73
m
2
)
Mean eGFR
between‑group
change/year
(chronic slope):
1.9 mL/min/1.73 m2
(FORXIGA/placebo)a

As well as preserving kidney function, FORXIGA
significantly reduces albuminuria in patients with CKD
Image adapted from Jongs N, et al, 2021
a
In this pre-specified analysis of the DAPA-CKD trial, participants had a median UACR of 949 mg/g (IQR: 477–1885). Compared with placebo, the geometric mean percentage
change in UACR was -26.5% at week 2 (95% CI: -22.1, -30.9; nominal P<0.0001) with dapagliflozin at Week 2. Follow-up visits occurred after 2, 4, and 8 months and then
at 4-month intervals thereafter. The UACR reduction was sustained through to the end of follow-up. Taking all follow-up UACR measurements into account,
dapagliflozin reduced geometric mean UACR by 29.3% (95% CI: -33.1, -25.2; nominal P<0.0001) relative to placebo; b
Error bars show 95% CIs
CKD, chronic kidney disease; OD, once daily; UACR, urine albumin:creatinine ratio
Jongs N, et al. Lancet Diabetes Endocrinol 2021;9:755–766
Adjusted
mean
change
in
UACR
(%)
0 4 8 12 16 20 24 28 36
0
-20
-40
-60
2 32
FORXIGA 10 mg OD
Placebo
Change from baseline in UACR in the dapagliflozin and placebo
groups in all participants in a prespecified analysis of DAPA-CKDa,b

BMI, body mass index; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; GDMT, guideline-directed medical therapy; HbA1c, haemoglobin A1C; HF, heart failure; OD, once daily; RASi,
renin-angiotensin system inhibitor; SGLT2, sodium–glucose co-transporter 2; T2D, Type 2 diabetes; UACR, urine albumin:creatinine ratio
1. Heerspink HJL, et al. N Engl J Med 2020;383:1436–1446; 2. Schechter M, et al. Ann Intern Med 2023;176:59–66; 3. Madero M, et al. Kid Med 2024; doi: https://doi.org/10.1016/j.xkme.2024.100851
After receiving treatment with FORXIGA, CRESTOR,
and a RASi, Mr. M’s CKD has stabilised
PATIENT
CHARACTERISTICS
At FORXIGA initiation
 UACR: 122 mg/g
 HbA1c: 140.1 mg/dL (6.5%)
LABORATORY RESULTS Following 6 months of
treatment with FORXIGA
 UACR: 100 mg/g
 HbA1c: 128.6 mg/dL (6.1%)
 LDL-C: 87 mg/dL
Following 2 years of treatment
with FORXIGA
 UACR: 92 mg/g
 HbA1c: 125.7 mg/dL (6.0%)
 LDL-C: 80 mg/dL
Starting treatment with
FORXIGA, CRESTOR, and a RASi
as part of GDMT may allow Mr.
M to live better, longer vs SoC1–
3
Your Patient
Profile Lab results
GDMT Summary
Clinical scenarios
1 2 3 4
Name:
Age:
BMI:
Smoker:
Mr. M
51 years old
22 kg/m2
No

You can delay the onset of dialysis by starting treatment earlya
Image adapted from Madero M, et al, 2024
a
Initial eGFR decline over the first 2 weeks was estimated using eGFR slope data from the acute phase of the DAPA-CKD trial. Projections are based on the eGFR from Week 2
to end of treatment (DAPA-CKD chronic phase) and assume linear progression of eGFR decline. Example patient with initial eGFR of 60 mL/min/1.73 m2
used eGFR slope data
from the DAPA-CKD trial subgroup with eGFR ≥45 mL/min/1.73 m2
; eGFR at the start of the chronic phase: FORXIGA 10 mg, 56.3 mL/min/1.73 m2
; placebo,
59.0 mL/min/1.73 m2
. Example patient with initial eGFR of 30 mL/min/1.73 m2
used eGFR slope data from the DAPA-CKD trial subgroup with eGFR <45 mL/min/1.73 m2
;
eGFR at the start of the chronic phase: FORXIGA 10 mg, 27.4 mL/min/1.73 m2
; placebo, 29.6 mL/min/1.73 m2
.
These estimates do not take into account competing risk of death, and they assume that adherence is maintained, that benefits are sustained over time, and that there are no longer-term adverse effects;
b
SoC included maximum tolerated labelled dose of an ACEi or ARB. Management of blood pressure, lipids and glucose, and the use of other essential therapies was left to the discretion of the investigator2
eGFR, estimated glomerular filtration rate; OD, once daily; SoC, standard of care
1. Madero M, et al. Kid Med 2024; doi: https://doi.org/10.1016/j.xkme.2024.100851; 2. Heerspink HJL, et al. Nephrol Dial Transplant 2020;35:274–282
estimated delay in
time to dialysis
Time (years)
eGFR
(mL/min/1.73
m
2
)
0 2 4
0
10
20
30
40
70
60
50
6 8 10 12 14 16 18 20 22 24 26
eGFR ≤10 mL/min/1.73 m2
Approx. 6
years
Approx. 11 years
Placebo + SoCb
FORXIGA + SoCb
Post-hoc modelling data from the placebo-controlled DAPA-CKD trial1
Initiation of FORXIGA at eGFR
60 mL/min/1.73 m2
vs placebo1
11year
~

Help your patients with CKD live longer by reducing
the risk of all-cause mortality1
a
DAPA-CKD was stopped early due to efficacy benefit.1
Because of this unplanned early stop, secondary endpoints are considered nominal; In DAPA-CKD, FORXIGA
demonstrated a 39% RRR in the primary composite endpoint of sustained ≥50% eGFR decline, ESKD, and CV or renal death, with an ARR of 5.3% and an NNT of 19 over the
median 2.4-year trial duration. In the secondary endpoint of all-cause mortality, FORXIGA demonstrated a 31% RRR, with an ARR of 2.1% (HR 0.69 [95% CI: 0.53–0.88]; p<0.004).
ARR, absolute risk reduction; CV, cardiovascular; eGFR, estimated glomerular filtration rate; ESKD, end-stage kidney disease; RRR, relative risk reduction; SoC, standard of care; T2D, Type 2 diabetes
1. Heerspink HJL, et al. N Engl J Med 2020;383:1436–1446; 2. FORXIGA 10 mg film-coated tablets. Product Information April 2024; 3. Jardiance 10 mg and 25 mg film-coated tablets. Summary of product
characteristics. May 2024; 4. Invokana 100 mg film-coated tablets. Summary of product characteristics. May 2024; 5. Steglatro 5 mg and 15 mg film-coated tablets. Summary of product characteristics. May
2024; 6. EMPA-KIDNEY Collaborative Group; Herrington WG, Staplin N, Wanner C, et al. N Engl Med 2023;388:117–127
DAPA-CKD secondary endpoint: All-cause mortality1a
FORXIGA is the only SGLT2 inhibitor shown to reduce
the risk of mortality vs placebo in patients with CKD1–6
31RRR
%
2.1 ARR
%
DAPA-CKD secondary endpoint1
vs placebo

Help your patients with CKD live better by reducing
the risk for hospitalisation
a
The study included a total of 4304 patients over a median follow-up of 2.4 years. Exploratory endpoint, no statistical significance analysis was conducted
ARR, absolute risk reduction; CI, confidence interval; CKD, chronic kidney disease; HR, hazard ratio; RRR, relative risk reduction
Schechter M, et al. Ann Intern Med 2023;176:59–66
DAPA-CKD post-hoc analysis: First and subsequent all-cause hospitalisationa
22 RRR
%
10.7 ARR
%
DAPA-CKD post-hoc analysis
HR 0.78 (95% CI: 0.70, 0.87)
vs placebo

Due to limited experience, it is not recommended to initiate treatment with FORXIGA in patients with eGFR <30 mL/min/1.73 m2
. If eGFR falls below 45 mL/min/1.73 m2
, additional glucose-lowering treatment
should be considered in patients with T2D for whom further glycaemic control is needed9
a
In DAPA-CKD, patients received FORXIGA or placebo on top of SoC which included maximum tolerated labelled dose of an ACEi or ARB10
;b
In the DAPA-HF trial, FORXIGA reduced the risk of the primary composite
endpoint of CV death and worsening HF (defined as hospitalisation for HF or urgent HF visit) in symptomatic HF patients. FORXIGA also reduced all-cause mortality and both components for the co-primary were
nominal.4
DAPA-CKD was stopped early due to efficacy benefit. Because of this unplanned early stop, secondary endpoints are considered nominal4
; c
As shown in DAPA-HF and across a range of EF in the pooled
analysis of DAPA-HF and DELIVER.3
In the DELIVER study CV death and all-cause mortality did not meet statistical significance1
ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CKD, chronic kidney disease; CV, cardiovascular; eGFR, estimate glomerular filtration rate; HF, heart failure; SGLT2, sodium–glucose
co-transporter 2; SoC, standard of care; T2D, Type 2 diabetes
1. Solomon SD, et al. N Engl J Med 2022;387:1089–1098; 2. McMurray JJV, et al. N Engl J Med 2019;381:1995–2008; 3. Jhund PS, et al. Nat Med 2022;28:1956–1964; 4. Heerspink HJL, et al. N Engl J Med
2020;383:1436–1446; 5. Madero M, et al. Kid Med 2024; doi: https://doi.org/10.1016/j.xkme.2024.100851; 6. Schechter M, et al. Ann Intern Med 2023;176:59–66; 7. Kidney Disease: Improving Global Outcomes.
Kidney Int 2024;105:S117–S314; 8. Shlipak MG, et al. Kidney Int 2021;99:34–47; 9. Forxiga Product Information Apr 2024
You can help Mr. M live better, longer with early diagnosis
and treatment with FORXIGA
Mr. M
Recently diagnosed
Early screening and intervention can help improve
outcomes for patients like Mr. M7,8
CKD screening should be initiated at diagnosis of
T2D, as evidence of CKD is often already apparent7
FORXIGA is the supported with clinical evidence from multiple studies proving it
reduces the risk of deathb
for patients with CKD or HF1–4,c
Early initiation of GDMT like FORXIGA can increase
patient’s QOL
Your Patient
Profile Lab results
GDMT Summary
Clinical scenarios
1 2 3 4

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