What’s in the pipeline for cardiometabolic medicine?
We now have unprecedented levels of research and development into drugs that can help manage cardiovascular risk, particularly in type 2 diabetes. Professor Naveed Sattar (University of Glasgow, UK) and Professor Darren McGuire (UT Southwestern, USA) get to grips with how this has come about and what new treatments we might look to in the future.
These are certainly exciting times for cardiometabolic medicine. As well as the new generation of antihyperglycaemics – the SGLT-2 inhibitors and GLP-1 receptor agonists, which have been shown to have cardiovascular benefits above and beyond their effect on blood glucose - there are promising developments in the fields of lipids and anti-inflammatories.
“Our toolbox has massively expanded, particularly in type 2 diabetes,” says Naveed. But he is quick to point out how unexpected some of these developments have been, citing in particular the benefits of SGLT-2 inhibitors for heart failure. Such unintended consequences have helped shed new light on the pathogenesis of cardiovascular disease in type 2 diabetes.
Darren agrees: “We had no conception that making glucose pee out in the urine would benefit the heart. I mean, how does that happen? But we’ve learned so much about biology and pathophysiology since - basically going back from the bedside to the bench, trying to understand this complex biology.”
One of the most striking messages in Naveed and Darren’s presentation is just how quickly things have changed in the cardiovascular R&D field over the last decade or so. The big bang in this respect, as Darren highlights, happened back in 2008, when the USA’s Food and Drug Administration (FDA) and European Medicines Agency made cardiovascular safety assessment a prerequisite of all drugs or medications for type 2 diabetes. Numerous large cardiovascular outcomes trials inevitably followed
“Most of the trials were somewhat overpowered for their non-inferiority target,” says Darren. “And with that benefit, we have had the opportunity now to demonstrate efficacy with selected therapies.”
There is a caveat however. “Now that we have proven therapies, where do we go? How long can we do placebo control in these trials? That’s a big question.”
With so many new treatments in the pipeline, it’s a question that is likely to be asked more and more frequently over the coming months and years.