Sodium-Glucose Co-transporter 2 Inhibitors in the Failing Heart: a Growing Potential.

Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are a new drug class designed to treat patients with type 2 diabetes (T2D). However, cardiovascular outcome trials showed that SGLT2i also offer protection against heart failure (HF)-related events and cardiovascular mortality. These benefits appear to be independent of glycaemic control and have recently been demonstrated in the HF population with reduced ejection fraction (HFrEF), with or without T2D. This comprehensive, evidence-based review focuses on the published studies concerning HF outcomes with SGLT2i, discussing issues that may underlie the different results, along with the impact of these new drugs in clinical practice. The potential translational mechanisms behind SGLT2i cardio-renal benefits and the information that ongoing studies may add to the already existing body of evidence are also reviewed. Finally, we focus on practical management issues regarding SGLT2i use in association with other T2D and HFrEF common pharmacological therapies. Safety considerations are also highlighted. Considering the paradigm shift in T2D management, from a focus on glycaemic control to a broader approach on cardiovascular protection and event reduction, including the potential for wide SGLT2i implementation in HF patients, with or without T2D, we are facing a promising time for major changes in the global management of cardiovascular disease.

Rifaximin for the treatment of hepatic encephalopathy.

PURPOSE: The use of rifaximin for the treatment of hepatic encephalopathy (HE) is reviewed. SUMMARY: HE is observed in approximately 50-70% of all patients with cirrhosis. Clinical manifestations of HE range from altered mental status to deep coma. Most manifestations of this syndrome are reversible with medical treatment. Treatment measures focus on the resolution of ammonia accumulation and identification/ removal of precipitating factors. Lactulose has been the mainstay of HE treatment in the acute and chronic settings, though its use is limited by poor patient tolerance and compliance. Chronic administration of antibiotics has also proven to be effective in HE. Historically, neomycin or metronidazole has been used, but both carry the risk of serious adverse effects. Rifaximin is a nonabsorbed derivative of rifamycin with a broad spectrum of activity against aerobic and anaerobic gram-positive and gram-negative organisms. Clinical trials have compared rifaximin to lactulose or neomycin for the treatment of HE. Rifaximin shows a general trend toward better efficacy versus lactulose or neomycin. In addition, rifaximin seems to offer a better safety and tolerability profile than that of lactulose and possibly neomycin. CONCLUSION: While no randomized, placebo-controlled studies have assessed the efficacy and long-term safety outcomes of rifaximin in the treatment of HE, rifaximin has demonstrated better efficacy and safety profiles compared with lactulose and neomycin. Future studies should assess HE outcomes with more consistent indexes and measurements and should compare the efficacy and safety of rifaximin with those of metronidazole.