A drug newly approved by the UAE for the treatment of heart failure is being used in some hospitals.
The Emirates Drug Establishment announced on Monday it had authorised the use of Inpefa (sotagliflozin), a treatment shown in clinical trials to reduce deaths linked to cardiovascular disease as well as hospital admissions and urgent medical visits for heart failure.
Heart failure, a chronic condition in which the heart cannot pump blood effectively, is a growing problem in the UAE, driven by high rates of diabetes, hypertension and coronary artery disease.
Dr Brajesh Mittal, head of cardiology at Medcare Hospital Al Safa, said the drug was already being used in some settings.
“In our hospital, it is available and being prescribed, and some patients have already started treatment,” he said, before adding trial data showed meaningful reductions in cardiovascular death and heart failure hospitalisation, with benefits emerging within weeks.
He added that studies suggest the drug can be started safely in patients while they are still in hospital.
“It was generally well tolerated in trials, with a safety profile consistent with what we expect from this class of drugs,” he said.
From a national perspective, earlier access to new therapies could make a real difference, Dr Mittal added. “Heart failure is a major concern and faster access to effective treatments can improve outcomes,” he said.
Need for solutions
Last year, The National reported how work stress and unhealthy lifestyles were triggering a rise in younger people with heart disease, with UAE doctors diagnosing cardiac problems up to 15 years earlier than elsewhere.
While the drug is already used by some, other cardiologists said it could take some time before it was widely available across the country. While the approval has been welcomed, doctors say regulatory clearance does not automatically mean the drug will be used routinely.
“The UAE is among the first countries in the world to approve Inpefa,” said Dr Jan Niclas Strickling, a consultant cardiologist at Medcare Hospital Al Safa. “But approval and real-world use are not the same thing. It is not yet being widely prescribed across all settings.”
He said access would depend on how quickly insurers, hospitals and pharmacies move to adopt the drug, which was previously approved for use in the US.
“Before it becomes routine, insurance coverage, hospital formularies and availability all need to be in place. That process can vary between healthcare providers and can take time,” he said.
Sotagliflozin differs from other drugs in the same class already used to treat heart failure because it works on both the kidneys and the gut, affecting how glucose is absorbed and excreted.
“That dual mechanism may offer additional benefits,” Dr Strickling said, “but we still need real-world experience to fully understand how it compares with established treatments.”
He said the drug may be most useful for patients who remain unwell despite standard therapy, particularly those at high risk of repeated hospital admissions.
“Every hospitalisation worsens long-term outcomes for heart-failure patients,” he said.
Other cardiologists urged caution against overselling the approval. Dr Georgie Thomas, a consultant cardiologist at Burjeel Hospital, said patients should not delay existing treatment in anticipation of the new drug.
“It’s not something I would tell my patients to wait for,” he said. “This is not a eureka moment – it’s another useful addition.”
Versatile drug
Dr Thomas said the strongest evidence for sotagliflozin was in patients whose heart failure is linked to diabetes.
“For those patients, it would likely be my first choice,” he said. “For non-diabetic patients, the SGLT2 inhibitors we already use work just as well.”
He added that new medications often take time to find their place in routine practice. “I haven’t prescribed it yet,” he said. “We’re aware of the drug, but uptake doesn’t happen overnight.”
Dr John Dennis, an associate professor of health data science at the University of Exeter in the UK, said that the use of SGLT2-inhibitor drugs was “very well-established” in the treatment of Type II diabetes. Their use for treating heart failure has, he said, increased in recent years.
There was much evidence, he indicated, for their benefits in “classic treatment for Type II diabetes”, namely in controlling blood-sugar levels, and in improving cardiovascular outcomes.
“There's really good evidence for people with and without diabetes that SGLT2 inhibitors are helpful in preventing heart failure, particularly in high-risk-people,” he said.
“The research is more advanced then with weight-loss medications in terms of their efficacy and the heart failure benefits.”
The use of dual-action drugs – namely those that are both SGLT1 and SGLT2 inhibitors, such as the drug now approved for use in the UAE – is still “very early stage”, he added.
The SGLT2 inhibitors have been “transformative” in the treatment of Type II diabetes, Dr Dennis said, with their benefits representing “a step-change in diabetes care”, with the drugs being widely recommended for use with Type II diabetes patients because of their heart disease benefits.
The safety profile of these SGLT2-inhibitor drugs is seen as very good although there are some risks when they are used in elderly patients with frailty, said Dr Dennis, whose own research looks at approaches to developing more personalised treatment for Type II diabetes patients.
