Empagliflozin superior to DPP-4 inhibitors, GLP-1 RAs for reducing heart failure hospitalizations: EMPRISE trial
USA: The initiation of empagliflozin versus a DPP-4 inhibitor in clinical practice is associated with a relative risk reduction for heart failure hospitalization (HHF) greater than 50%, findings from the EMPRISE trial have revealed. And empagliflozin initiation versus GLP-1 receptor agonists was associated with a greater than 30% reduction in HHF.
The study findings were presented at the American Diabetes Association (ADA) 82nd Scientific Sessions and subsequently published in the journal Diabetes, Obesity and Metabolism.
"Empagliflozin initiation versus DPP-4 inhibitor is associated with a lower risk of HHF, all-cause mortality (ACM), and myocardial infarction (MI)/stroke/ACM, a similar risk of MI/stroke, and a safety profile consistent with documented information," Elisabetta Patorno, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA, and colleagues wrote in their study.
The study was conducted with the objective to investigate safety and effectiveness outcomes among patients with type 2 diabetes (T2D) initiating empagliflozin versus dipeptidyl peptidase-4 (DPP-4) inhibitor treatment across the broad spectrum of cardiovascular risk in a population-based cohort study.
The researchers used data from 2 US commercial insurance databases and Medicare between August 2014 and September 2017 to identify 39 072 pairs of 1:1 propensity score-matched adult patients with T2D initiating empagliflozin or DPP-4 inhibitors.
A composite myocardial infarction /stroke, and hospitalization for heart failure was the primary outcome. Safety outcomes included lower-limb amputations (LLAs), bone fractures, acute kidney injury (AKI), and diabetic ketoacidosis (DKA).
The study led to the following findings:
- Study participants had a mean age of 60 years and only 28% had established cardiovascular disease.
- Compared to DPP-4 inhibitors, empagliflozin was associated with a similar risk of MI/stroke (HR 0.99), and a lower risk of HHF (HR 0.48 and 0.63, based on a primary and any heart failure discharge diagnosis, respectively).
- The HR was 0.52 for all-cause mortality (ACM) and 0.83 for a composite of MI/stroke/ACM.
- Empagliflozin was associated with a similar risk of LLA and fractures, an increased risk of DKA (HR 1.71), and a decreased risk of AKI (HR 0.60).
"The study underlines the magnitude of impact use of SGLT2 inhibitors can provide compared with other glucose-lowering therapies," wrote the authors.
Reference:
Patorno E, Pawar A, Wexler DJ, Glynn RJ, Bessette LG, Paik JM, Najafzadeh M, Brodovicz KG, Déruaz-Luyet A, Schneeweiss S. Effectiveness and safety of empagliflozin in routine care patients: Results from the EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study. Diabetes Obes Metab. 2022 Mar;24(3):442-454. doi: 10.1111/dom.14593. Epub 2021 Dec 1. PMID: 34729891; PMCID: PMC8939295.
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