Empagliflozin linked to lower cardiovascular risk and renal events in real-world study

An analysis of patient information from large European and Israeli databases demonstrated that type 2 diabetes treatment with empagliflozin significantly reduced likelihoods for various undesirable cardiovascular and renal outcomes compared with a dipeptidyl peptidase-4 (DPP-4) inhibitor.

As there is a high prevalence of concomitant heart failure (HF) in diabetics, the impact of anti-diabetic medication on cardiovascular and renal outcomes may play a role in HF therapy [1]. A large, non-interventional study compared type 2 diabetes treatment with the sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin with therapy with a DPP-4 inhibitor in terms of primary cardiovascular and secondary renal effectiveness outcomes [2].

Between 2014 and 2019, data was collected from large databases and registries in Sweden, Finland, Germany, Spain, and Isreal. Included were >75,000 adults who started diabetes treatment with either empagliflozin (n=38,203) or a DPP-4 inhibitor (n=38,203). The mean age was a little over 60 years, and most patients were men. Logistic regression was used for the analysis based on propensity score matching.

Prof. Leo Niskanen (University of Eastern Finland, Finland) presented the results as pooled incidence rates and hazard ratios for the comparison of empagliflozin versus DPP-4 inhibitor. The incidence rate of hospitalisation for HF was 7.36 per 1,000 patient-years with empagliflozin compared with 11.86 per 1,000 patient-years with DPP-4 inhibitor (HR 0.60; 95% CI 0.50–0.72; see Table). Likewise, an HR of 0.52 (95% CI 0.39–0.69) for all-cause mortality indicated significant superiority of empagliflozin. “If we then look at the composite outcome including hospitalisation for HF and all-cause mortality, we can see that this was clearly in favour of empagliflozin with a 40% lower risk, which was highly significant,” Prof. Niskanen pointed out.

Table: Empagliflozin versus DPP-4 inhibitor reduced the risk of cardiovascular and renal events in the EMPRISE study [2]
Shown are pooled incidence rates and pooled hazard ratios of events among empagliflozin versus DPP-4 inhibitor users in 1:1 propensity score-matched populations.
CI, confidence interval; DDP-4i, dipeptidyl peptidase-4 inhibitor; EMPA, empagliflozin; FU, follow-up; HR, hazard ratio; IR, incidence rate; MI, myocardial infarction; PY, patient-years.

The second composite of myocardial infarction, stroke, and all-cause mortality, resulted in a 36% reduced likelihood for patients in the empagliflozin group (HR 0.64; 95% CI 0.52–0.80). The researchers also assessed myocardial infarction, stroke (pooled HR 0.71; 95% CI 0.56–0.90), and end-stage renal disease (pooled HR 0.40; 95% CI 0.17–0.95) for empagliflozin versus DPP-4 inhibitor. However, the individual outcome of myocardial infarction was non-significant (HR 0.95; 95% CI 0.74–1.22).

“These results complement the results from the clinical trial EMPA-REG OUTCOME (NCT01131676) and support changes recently made in the ADA and EASD consensus update,” underlined Prof. Niskanen in his conclusion.

1. 
   
   1. Lehrke M, et al. Am J Cardiol. 2017;120(1S):S37–S47.
   2. Niskanen L, et al. Empagliflozin use versus dipeptidyl peptidase 4 inhibitors reduces risk of cardiovascular. Heart Failure and World Congress on Acute Heart Failure 2021, 29 June–1 July.

 

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Posted on 19 August, 202122 February, 2024