Combo of empagliflozin plus MRA safe in HFpEF patients, may reduce hyperkalemia risk: JACC
Delhi: A recent study has found that treatment with empagliflozin improves clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF), regardless of background mineralocorticoid receptor antagonist (MRA) therapy.
"The combination of MRAs and empagliflozin is safe in HFpEF patients and empagliflozin may reduce hyperkalemia risk in patients taking MRAs, which is a frequent reason why clinicians stop MRAs," João Pedro Ferreira, Unidade de Investigaçao Cardiovascular, Faculdade de Medicina Universidade do Porto, Porto, Portugal, and colleagues wrote in their study published in the Journal of the American College of Cardiology (JACC).
In HFpEF patients, MRAs may be beneficial in reducing heart failure hospitalizations. There has been no study on the effect of sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors) in patients with HF with preserved ejection fraction according to MRA background therapy.
Against the above background, Dr Ferreira and the team aimed to examine the effect of empagliflozin in MRA users and nonusers in the EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved Ejection Fraction) trial.
For this purpose, the researchers conducted survival analyses comparing the effects of empagliflozin vs placebo in MRA users and nonusers at baseline with treatment-by-MRA use interaction terms.
Following were the study's key findings:
- A total of 5,988 patients were included, of whom 2,244 (37.5%) were using MRAs at baseline. MRA users had higher event rates than MRA nonusers (placebo group primary outcome 9.4 vs 8.2 events per 100 person-years).
- The benefit of empagliflozin to reduce the primary outcome was not significantly different between MRA nonusers and MRA users (HR: 0.73 and HR: 0.87).
- The effect of empagliflozin to reduce first and recurrent HF hospitalizations was more pronounced in MRA nonusers than in MRA users (HR: 0.60 and HR: 0.90).
- MRA users experienced almost twice as many hyperkalemia events as MRA nonusers, and empagliflozin reduced the risk for hyperkalemia or initiation of potassium binders regardless of MRA use (MRA nonusers: HR: 0.90; MRA users: HR: 0.74).
"The results showed that the benefit of empagliflozin to reduce the primary outcome was not significantly different between MRA nonusers and MRA users," wrote the authors. "Empagliflozin's effect to reduce first and recurrent HF hospitalizations was more pronounced in MRA nonusers. Further, empagliflozin was shown to reduce hyperkalemia, with no significant treatment-by-MRA subgroup interaction."
Reference:
The study titled, 'Mineralocorticoid Receptor Antagonists and Empagliflozin in Patients With Heart Failure and Preserved Ejection Fraction," was published in the Journal of the American College of Cardiology (JACC).
DOI: https://www.jacc.org/doi/10.1016/j.jacc.2022.01.029
KEYWORDS: empagliflozin, heart failure, preserved ejection fraction, SGLT2 inhibitors, mineralocorticoid receptor antagonists, JACC, EMPEROR-Preserved trial, João Pedro Ferreira, hospitalization, hyperkalemia
