Desai H, Solanki S, Jossy PE. Sotagliflozin in the management of heart failure: a comprehensive review of mechanisms, evidence, and clinical implications. Series Clin Med Case Rep Rev. 2025;3(2):1-6.
Heart failure (HF) and type 2 diabetes mellitus (T2DM) frequently coexist, substantially increasing cardiovascular (CV) risk and mortality. Sodium-glucose co-transporter 2 inhibitors (SGLT2is) have revolutionized the management of T2DM and HF by demonstrating CV and renal protective effects beyond glucose lowering. Among these, sotagliflozin, a dual SGLT1/SGLT2 inhibitor, offers additional metabolic benefits via gastrointestinal glucose modulation. This review comprehensively integrates findings from 27 studies analyzing sotagliflozin and SGLT2is in HF and diabetes.
The SOLOIST-WHF trial demonstrated sotagliflozin’s efficacy in reducing CV death, HF hospitalizations, and urgent HF visits in T2DM patients following HF exacerbation. Meta-analyses confirmed reductions in major adverse cardiovascular events (MACE), all-cause mortality, and HF hospitalization. Sotagliflozin’s dual mechanism further improves postprandial glycemic control, elevates GLP-1/GIP secretion, and may enhance myocardial efficiency, particularly in heart failure with preserved ejection fraction (HFpEF). Sotagliflozin also demonstrated safety and efficacy in type 1 diabetes mellitus (T1DM), reducing insulin needs and glucose variability.
Safety profiles align with SGLT2is, generally, but with additional gastrointestinal side effects from SGLT1 inhibition. Cost-effectiveness models project an incremental cost-effectiveness ratio (ICER) of ~$45,596/QALY. Real-world eligibility studies suggest broad applicability of sotagliflozin in HF patients. Early initiation post-HF hospitalization offers rapid clinical benefit, while renoprotection remains robust even in advanced chronic kidney disease (CKD).
This review highlights sotagliflozin’s unique dual mechanism, early benefits, and broad applicability, positioning it as a promising option for HF patients with diabetes.