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Sotagliflozin and decompensated heart failure: results of the SOLOIST-WHF trial

Heart Failure (HF) is a chronic complex clinical syndrome that results as a direct abnormality of cardiac function. In the United States alone, about 6.2 million adults are affected by HF, and in 2018, HF was mentioned on 379,800 death certificates (13.4%) [1]. It has an estimated 30.7 USD billion dollar health-care cost, which includes the financial burden of health services, medicines to treat HF, and missed days of work [2]. Any type of structural or functional impairment of ventricular filling that causes the heart to pump inadequately can lead to HF. Several symptoms associated with this syndrome are a direct result of the heart inadequately pumping blood at a rate to commensurate with the requirements of metabolizing tissues. In a chronic state, this failure can be taxing on other organs and is especially detrimental for those patients with chronic conditions, including hypertension and diabetes. In fact, the risks of developing cardiovascular disease are twofold among diabetic patients [3]. By 2030, it is estimated that diabetes will affect 440 million people, which consequently will also increase the population with cardiovascular disease [4]. Sotagliflozin is a new novel oral antidiabetic drug that belongs to a class of sodium–glucose co-transporter 2 (SGLT2) inhibitors. This antidiabetic agent has a unique dualreceptor binding affinity for both SGLT1 the primary transporter for glucose absorption in the gastrointestinal tract and SGLT2, which is expressed in the kidney where it inhibits glucose reabsorption in the proximal tubules. Consequently, this leads to insulin-independent reduction in plasma glucose concentration, and thus has become a successful treatment option for patients with Type 2 diabetes mellitus (T2DM). However, the benefits of SGLT2 inhibitors are not limited to glycemic control. Several studies, including DAPA-HF and EMPEROR-reduced trials, have proved the efficacy of SGL2 in reducing all-cause and cardiovascular deaths in patients with HF with reduced ejection fraction (HFrEF). However, the safety and efficacy of SGLT2 inhibitors when initiated shortly after a decompensated HF event were unknown until recently, as the results of the SOLOIST-WHF Trial were made available. The trial investigates the safety and efficacy of Sotagliflozin in reducing cardiovascular events in patients with type 2 diabetes (T2DM) with recent admissions for HF. 2. Sotagliflozin – unique mechanism of action and benefits