Real-world data show clinical benefit of empagliflozin, which is likely a class effect
Lower Risk of Heart Failure and Death in Patients Initiated on SGLT-2 Inhibitors Versus Other Glucose-Lowering Drugs: The CVD-REAL StudyLiterature - Kosiborod M, Cavender MA, Fu AZ, et al. - Circulation 2017; published online ahead of print
- Compared to patients on oGLDs, patients initiated on SGLT-2 inhibitors were younger, less likely to have chronic kidney disease or CV complications, more likely to have microvascular disease, more likely to receive statins, anti-hypertensive drugs, and other glucose-lowering medication classes at baseline, and less likely to receive loop diuretics.
- The baseline characteristics were well-balanced between groups post-matching and the standardized differences for most variables were <10%.
- The mean age was 57 years, 44% were women, 13% had established CVD, 67% of patients received statins, 80% anti-hypertensive medications, 74% ACEi/ARBs, and 79% metformin.
- The initiation of SGLT-2 inhibitor vs. oGLD was associated with a lower risk of HHF (pooled HR 0.61, 95% CI 0.51–0.73, P<0.001) and a lower risk of death (pooled HR 0.49, 95% CI 0.41–0.57, P<0.001), as well as with a lower risk of the composite outcome of HHF or death (pooled HR 0.54, 95% CI 0.48–0.60, P<0.001).
- Sensitivity analysis including multivariate adjustment, stepwise removal of specific oGLD classes and comparisons within geographic region, yielded similar results.
In a large multinational study, treatment of T2DM patients with SGLT-2 inhibitors versus oGLDs was associated with lower rates of HHF and death in a real-world setting. Since the overwhelming majority of patients did not have established CVD, this suggests that the benefits of SGLT-2 inhibitors on the prevention of heart failure may extend to lower-risk patients than those enrolled in randomized trials so far. Moreover, as there is substantial variation in SGLT2 inhibitor use between geographic regions and no heterogeneity in results was observed across counties, this suggests that there is likely a class effect for SGLT-2 inhibitors.