New data from the Phase III DAPA-HF trial showed Farxiga (dapagliflozin) reduced the worsening of heart failure or cardiovascular death in HFrEF patients with and without chronic kidney disease

AstraZeneca today announced a pre-specified sub-analysis from the landmark Phase III DAPA-HF trial investigating Farxiga (dapagliflozin) for the treatment of heart failure (HF). The data showed that Farxiga on top of standard of care reduced the incidence of the primary composite endpoint of cardiovascular (CV) death or worsening of HF in patients with HF with reduced ejection fraction (HFrEF), irrespective of the presence of chronic kidney disease (CKD).

These data were presented today at the American Society of Nephrology (ASN) Kidney Week 2019, which takes place from 5-10 November 2019 in Washington, DC, US.

Elisabeth Björk, Senior Vice President, Head of Late-stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, said: “These results underscore our commitment to reduce the burden of cardiovascular, renal and metabolic diseases. Heart failure affects 64 million patients worldwide,2 and more than 40% of people living with heart failure have chronic kidney disease, considerably worsening their prognoses and reducing their probability of survival.3,4 We are proud our research will help support potential solutions for the millions of people impacted by these interrelated diseases.”

DAPA-HF is the first outcomes trial with an SGLT2 inhibitor investigating the treatment of HF in patients with HFrEF with and without type-2 diabetes (T2D). In the sub-analysis, Farxiga treatment was associated with a 28% relative risk reduction (absolute risk reduction 19.9% vs. 26.3%, HR 0.72 [95% CI 0.59-0.86]) for the composite of CV death or worsening HF event in patients with CKD (estimated glomerular filtration rate [eGFR] < 60 ml/min/1.73m2 at baseline) and by a similar magnitude in those patients without CKD (13.8% vs. 17.6%, HR 0.76 [95% CI 0.63, 0.92]).

The sub-analysis also suggested that Farxiga may attenuate the long-term decline in glomerular filtration rate (GFR) in patients with HF after the expected initial small reduction in eGFR. The rates of amputation, fracture, volume depletion and renal adverse events were balanced between treatment groups in both the patients with and without CKD.1

These data add to the scientific evidence for Farxiga, which is now approved in the U.S. to reduce the risk of hospitalisation for heart failure (hHF) in adults with T2D and established CV disease or multiple CV risk factors, based on results from the landmark Phase III DECLARE-TIMI 58 trial.

DECLARE-TIMI 58 is the largest CV outcomes trial conducted for an SGLT2 inhibitor to date, evaluating T2D patients with multiple CV risk factors or established CV disease.5  A new sub-analysis from that trial showed that Farxiga slowed the progression of renal disease across all subgroups of patients with T2D, including patients with normal kidney function and in patients with normo-albuminuria.6 Farxiga attenuated the eGFR decline in patients with T2D overall and in subgroups based on baseline eGFR, urine albumin-to-creatinine ratio (UACR), use of ACEi/ARB and diuretics.6 Although only nominally significant, as endpoints were exploratory, fewer patients experienced an eGFR decline of 30% (HR 0.68 [95% CI 0.58, 0.79], p<0.002), 40% (HR 0.54 [95% CI 0.43, 0.67], p<0.002), or 50% (HR 0.57 [95% CI 0.40, 0.81], p<0.002) to eGFR <60 ml/min/1.73m2 with Farxiga versus placebo.

AstraZeneca announced in August 2019 that the US Food and Drug Administration (FDA) granted Fast Track designation for the development of Farxiga to delay the progression of renal failure and prevent CV and renal death in patients with CKD. The Phase III DAPA-CKD trial evaluates the effect of Farxiga on renal outcomes and CV mortality in patients with CKD with and without T2D versus placebo, on top of standard of care. Additionally, in September 2019, the FDA granted Fast Track designation for Farxiga to reduce the risk of CV death, or the worsening of HF in adults with HFrEF or HF with preserved ejection fraction (HFpEF) based on the Phase III DAPA-HF and DELIVER trials.


DAPA-HF (Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure) is an international, multi-centre, parallel group, randomised, double-blind trial in patients with heart failure and reduced ejection fraction (LVEF ≤ 40%), with and without T2D, designed to evaluate the effect of Farxiga 10mg, compared with placebo, given once daily in addition to standard of care. The primary composite outcome was time to a worsening heart failure event (hospitalisation or equivalent event; i.e. an urgent heart failure visit), or cardiovascular death.

The full results of the DAPA-HF trial were published in The New England Journal of Medicine in September 2019.


DECLARE (Dapagliflozin Effect on Cardiovascular Events)-TIMI 58 is the largest CV outcomes trial conducted for a selective inhibitor of SGLT2 to date in a broad patient population. It is an AstraZeneca-sponsored, Phase III, randomised, double-blind, placebo-controlled, multicentre trial, designed to evaluate the effect of Farxiga compared with placebo on CV outcomes in adults with T2D at risk of CV events, including patients with multiple CV risk factors or established CV disease and also assessed key renal secondary endpoints. The trial includes more than 17,000 patients across 882 sites in 33 countries and is independently run in collaboration with academic investigators from the TIMI study group (Boston, US) and the Hadassah Hebrew University Medical Center (Jerusalem, Israel).

The full results of the DECLARE-TIMI 58 trial were published in The New England Journal of Medicine in January 2019.

About Farxiga

Farxiga is a first-in-class, oral once-daily SGLT2 inhibitor indicated as both monotherapy and as part of combination therapy to improve glycaemic control, with the additional benefits of weight loss and blood-pressure reduction, as an adjunct to diet and exercise in adults with T2D. Farxiga has a robust programme of clinical trials that includes more than 35 completed and ongoing Phase IIb/III trials in more than 35,000 patients, as well as more than 2.5 million patient-years’ experience.

About AstraZeneca in CVRM

Cardiovascular, Renal & Metabolism (CVRM) together forms one of AstraZeneca’s three therapy areas and is a key growth driver for the Company. By following the science to understand more clearly the underlying links between the heart, kidneys and pancreas, AstraZeneca is investing in a portfolio of medicines to protect organs and improve outcomes by slowing disease progression, reducing risks and tackling comorbidities. The Company’s ambition is to modify or halt the natural course of CVRM diseases and potentially regenerate organs and restore function, by continuing to deliver transformative science that improves treatment practices and cardiovascular health for millions of patients worldwide.

About AstraZeneca

AstraZeneca is a global, science-led biopharmaceutical company that focuses on the discovery, development and commercialisation of prescription medicines, primarily for the treatment of diseases in three therapy areas - Oncology, CVRM, and Respiratory. AstraZeneca operates in over 100 countries and its innovative medicines are used by millions of patients worldwide. For more information, please visit and follow the Company on Twitter @AstraZeneca



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1.      Solomon et al. 2019 The Dapaglifozin in Heart Failure with Reduced Ejection Fraction trial (DAPA-HF): Outcomes in patients with CKD and effects on renal function. Presented at the American Society of Nephrology Kidney Week 2019 (ASN 2019); November 5th –10th, Washington, DC Abstract #FR-OR133

2.      Vos T et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet 2017; 390(10100):1211–59.

3.      Shiba N, Shimokawa H. Chronic kidney disease and heart failure—Bidirectional close link and common therapeutic goal. J Cardiol 2011; 57(1):8–17.

4.      United States Renal Data System. (2019). 2018 annual data report of the United States Renal Data System. Retrieved from

5.      Wiviott SD et al. The design and rationale for the Dapagliflozin Effect on Cardiovascular Events (DECLARE)-TIMI 58 Trial. Am Heart J 2018; 200:83–9.

6.      Mosenzon O. et al. 2019 Prevention of chronic kidney disease with dapagliflozin: analysis of the DECLARE-TIMI 58 trial. Presented at the American Society of Nephrology Kidney Week 2019 (ASN 2019); November 5th –10th, Washington, DC Abstract #TH-PO1205