During a unique symposium Monday afternoon, four experts will be put on the spot when they’re asked to pick the best medication to prevent a cardiovascular (CV) event in a type 2 diabetes patient with established heart disease or at high risk for heart disease. Each panelist can advocate for only one treatment option.
The two-hour presentation, Interpreting Cardiovascular Outcomes Trials—Implications for Practice, will begin at 4:30 p.m. CT Monday, June 15.
Symposium Chair Yehuda Handelsman, MD, will present a case study of a patient with type 2 diabetes who is a “poster candidate” for all four therapies: a glucagon-like peptide 1 (GLP-1) receptor agonist, a sodium glucose co-transporter 2 (SGLT2) inhibitor, a proprotein convertase subtilisin/kexin type 9 serine protease (PCSK9) inhibitor, and icosapent ethyl, an omega-3 fatty acid found in fish oil. The catch: Because of outside factors such as cost and insurance concerns, only one of the four therapies can be administered. Each presenter will make the case for what makes their therapy the optimal choice.
“I did a similar exercise about a year ago and I had some of the top people in this country in endocrinology, cardiology, and nephrology say, ‘It’s not fair what you’re doing. Don’t make us choose one—we want to give all of them,” said Dr. Handelsman, Medical Director and Principal Investigator at The Metabolic Institute of America. “Sometimes, we need to choose. I hope, with the help of these experts, that we also will help develop more patients’ characteristics to know which drug will better help which patients, adding clinical perspective and recommendations beyond the guidelines.”
In recent years, several drugs have been found to provide CV benefits for patients with type 2 diabetes, Dr. Handelsman noted. But the specific mechanisms of the CV benefits remain unknown for most of the drugs, and current guidelines are vague about which therapies are preferred for specific type 2 diabetes patients who have significant CV risk.
“There are no specifics now about which patient type should get which medication,” Dr. Handelsman said. “What we are trying to do is close this gap and provide a clinical tool about how to manage these patients. We want to guide clinicians about which type of patient would benefit from each class of drug.”
Christopher P. Cannon, MD, Education Director of Cardiovascular Innovation at Brigham and Women’s Hospital and Professor of Medicine at Harvard Medical School, will make the case for PCSK9 inhibitors during the session. He acknowledged that it will be difficult to choose only one treatment approach. The ideal solution may be multiple medications, Dr. Cannon said, because they complement each other so well. But he also understands that there can be issues around cost, insurance coverage, and a patient’s willingness to add more drugs to their regimens.
“Before, we had one or two new therapies that we could add,” Dr. Cannon said. “But now that’s a little bit of an issue because we have so many good things, how do you prioritize them? There are costs, and then there can be battles with the insurance company. It can be hard when those are the reasons we can’t offer patients the best treatments, so we try hard to get our patients access to all beneficial therapies.”
Sergio Fazio, MD, PhD, Director of the Center for Preventive Cardiology and Professor of Medicine in the Division of Cardiovascular Medicine at Oregon Health & Science University, will make the case for icosapent ethyl during the session. Ofri Mosenzon, MD, MSc, Professor of Internal Medicine at Hadassah Hebrew University Hospital in Jerusalem, Israel, will argue in favor of GLP-1 receptor agonists. And Sunder Mudaliar, MD, Clinical Professor of Medicine at the University of California, San Diego School of Medicine, will argue in favor of SGLT2 inhibitors.