SGLT2i in routine clinical practice reduces CV and renal events compared to DPP-4i in T2DM

ESC HF 2021 Use of empagliflozin was associated with reduced risk of CV and renal events, and all-cause mortality compared to use of DPP-4i in T2DM patients in a real world setting.

Presented at the ESC HF congress 2021 by: Leo Niskanen (Helsinki, Finland)

Introduction and Methods

In the EMPRISE study, the effectiveness of the SGLT2 inhibitor empagliflozin was compared with dipeptidyl peptidase-4 (DPP-4) inhibitors in routine clinical practice in T2DM patients across Europe and Israel. Outcomes were CV and renal effectiveness, safety, healthcare resource utilization and costs of empagliflozin compared to DPP-4i. Results were compared to findings from RCTs.

In this study, outcomes of CV and renal effectiveness were reported.

Large administrative databases and registers in Finland, Germany, Spain, Sweden and Israel from 2014-2019 were used. Adults ≥18 years with T2DM who initiated empagliflozin or DPP-4i for the first time were enrolled in the study. 1:1 Propensity score matching was applied. There were 38203 individuals on empagliflozin and 38203 users of DPP4-i. Individual CV effectiveness outcomes were hospitalization for HF (HHF), MI, stroke, and all-cause mortality. Individual renal outcomes were end-stage renal disease. The first composite outcome was HHF and all-cause mortality, the second composite outcome was MI, stroke and all-cause mortality.

Main results

• Individual outcomes of HHF, and all-cause mortality were reduced in empagliflozin users compared to DPP-4i users (HR 0.60, 95%CI: 0.50-0.72, and HR 0.52, 95%CI: 0.39-0.69, respectively).
• Composite outcome of HHF and all-cause mortality and composite outcome of MI, stroke and all-cause mortality were reduced in empagliflozin users compared to DPP-4i users (HR 0.60, 95%CI: 0.44-0.81, and HR 0.64, 95%CI: 0.52-0.80, respectively).
• Individual outcome of MI was not different between the two groups and stroke was reduced in the empagliflozin group compared to the DPP-4i group (HR 0.71, 95%CI: 0.56-0.90).
• End-stage renal disease was reduced in those who used empagliflozin compared to DPP-4i users (HR 0.40, 95%CI: 0.17-0.95).

Conclusion

The EMPRISE study showed that use of empagliflozin in real world reduced risk of CV and renal events and all-cause mortality compared to use of DPP-4i in patients with T2DM in Europe and Israel. The results complement the findings from the EMPA-REG OUTCOME trial.