Know How Inpefa Stacks Up to Other SGLT2 Inhibitors

New Inpefa (sotagliflozin) will try to compete with other SGLT2 inhibitors (Farxiga, Jardiance, etc).

Inpefa is NOT approved for managing type 2 diabetes yet...although A1c lowering seems similar to other SGLT2 inhibitors.

Instead, expect reps to tout Inpefa to reduce heart failure risk...especially for patients with a recent HF hospitalization.

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In patients with type 2 diabetes hospitalized for HF, adding Inpefa within a couple days of discharge prevents HF urgent care visits, hospitalizations, or CV death in about 1 in 6 patients over 9 months.

But don’t think of Inpefa as having any advantage over other SGLT2 inhibitors.

For example, data also support starting Jardiance (empagliflozin) in stabilized patients with HF before discharge.

Plus Farxiga (dapagliflozin) and Jardiance have more evidence overall for improving HF outcomes...including over a longer period of follow-up AND in HF with preserved ejection fraction.

And Inpefa costs about $600/month...similar to the others.

Caution about key risks with any SGLT2 inhibitor...genital yeast infections, volume depletion, rare Fournier’s gangrene, etc.

But be aware, Inpefa also increases risk of diarrhea...possibly because it blocks SGLT1 in the gut more than other meds in this class.

Don’t jump to Inpefa. Continue to recommend an SGLT2 inhibitor based on indication and payer preference.

For example, think about ADDING an SGLT2 inhibitor for patients with symptomatic heart failure with reduced ejection fraction despite optimized triple therapy. Benefits are likely a class effect.

Keep in mind, SGLT2 inhibitors can be started down to an eGFR of 20 mL/min/1.73 m2 for HF benefits...and continued until dialysis starts.

For a deeper dive into the evidence for SGLT2 inhibitors, see our resource, Diabetes Medications: Cardiovascular and Kidney Impact.

Key References

  • N Engl J Med. 2021 Jan 14;384(2):117-128
  • N Engl J Med. 2021 Jan 14;384(2):129-139
  • Circulation. 2022 May 3;145(18):e895-e1032
  • J Am Coll Cardiol. 2023 May 9;81(18):1835-1878
  • Medication pricing by Elsevier, accessed Jun 2023
Pharmacist's Letter. July 2023, No. 390709

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