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Empagliflozin for Type 2 Diabetes Elicits Superior Cardiorenal Outcomes – Renal and Urology News

Empagliflozin vs cardioprotective glucagon-like peptide-1 receptor agonists (GLP-1RAs) is associated with lower risks for major adverse cardiovascular events (MACEs) and other cardiorenal outcomes, according to study findings published in Cardiovascular Diabetology

Previous research findings support the links between the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors and GLP-1RAs and reductions in MACEs among patients with type 2 diabetes and established cardiovascular diseases. However, no studies have compared the effects of SGLT2 inhibitors with GLP-1RAs across a broad spectrum of patients.

Researchers conducted the EMPagliflozin compaRative effectIveness and SafEty (EMPRISE; ClinicalTrials.gov Identifier: NCT03363464) cohort study to compare the cardiorenal effects of empagliflozin and GLP-1RAs. Participants were adults with type 2 diabetes who were prescribed empagliflozin or a cardioprotective GLP-1RA (liraglutide, albiglutide, dulaglutide, or injection semaglutide) from August 2014 through September 2019.

The primary outcomes were a composite of myocardial infarction or stroke, hospitalization due to heart failure (HHF), and MACEs.

The study included a total of 141,541 matched patients in both the empagliflozin group and the GLP-1RA group. The average ages of patients on empagliflozin and a GLP-1RA were 64 years and 62 years, respectively. Patients on a GLP-1RA were more likely to be a woman compared with patients on empagliflozin (54% vs 43%). 

Our findings complement existing trial evidence by directly comparing empagliflozin with alternative cardioprotective agents and incorporating broad patient populations in clinical practice using robust and generalizable methodology.

Empagliflozin and GLP-1RA initiators showed similar rates of composite myocardial infarction or stroke (hazard ratio [HR], 0.99; 95% CI, 0.92-1.07; rate difference [RD], -0.23; 95% CI, -1.25 to 0.79). Patients on empagliflozin had lower HHF rates compared with those on a GLP-1RA (HR, 0.69; 95% CI, 0.62-0.77; RD, -2.28; 95% CI, -2.98 to -1.59).

The researchers identified a slightly lower risk for MACEs among patients on empagliflozin compared with those on a GLP-1RA (HR, 0.90; 95% CI, 0.82-0.99; RD, -2.54; 95% CI, -4.76 to -0.32). The composite cardiovascular mortality or HHF rates were also lower among patients on empagliflozin compared with those on a GLP-1RA (HR, 0.77; 95% CI, 0.69-0.86; RD, -4.11; 95% CI, -5.95 to -2.29).

In a subgroup analysis of patients with baseline chronic kidney disease stage 3 or 4, empagliflozin vs GLP-1RAs was associated with a lower risk for end stage kidney disease (HR, 0.75; 95% CI, 0.60-0.94; RD, -6.77; 95% CI, -11.97 to -1.61). 

Study limitations are the high specificity and low sensitivity associated with claims-based algorithms, short median follow-up time, and potential informative censoring. 

“Our findings complement existing trial evidence by directly comparing empagliflozin with alternative cardioprotective agents and incorporating broad patient populations in clinical practice using robust and generalizable methodology,” the researchers concluded.

Disclosure: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Endocrinology Advisor

References:

Htoo PT, Tesfaye H, Schneeweiss S, et al. Cardiorenal effectiveness of empagliflozin vs. glucagon-like peptide-1 receptor agonists: final-year results from the EMPRISE study. Cardiovasc Diabetol. Published February 8, 2024. doi:10.1186/s12933-024-02150-0