HF in T2D: real-world data demonstrate benefit of empagliflozin

  • Patorno E & al.
  • Circulation
  • 8 Apr 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Compared with sitagliptin (Januvia), initiation of empagliflozin (Jardiance) is associated with decreased risk for heart failure (HF) hospitalization (HHF) among patients with type 2 diabetes (T2D), with or without cardiovascular disease (CVD) history, treated in routine care.

Why this matters

  • Preliminary real-world data support EMPA-REG OUTCOME clinical trial findings.  

Study design

  • Propensity score-matched cohorts of patients with T2D initiating empagliflozin or sitagliptin with 16,443 in each group, including about 25% overall with CVD and 5% with HF history.
  • HHF outcome defined as HF discharge diagnosis in primary position (HHF-specific) or in any position (HHF-broad).
  • Funding: Boehringer-Ingelheim.

Key results

  • Incidence rates/1000 person-years in empagliflozin vs sitagliptin propensity score-matched initiators:
    • 2.1 vs 6.7 for HHF-specific, and
    • 10.5 vs 22.2 for HHF-broad outcomes.
  • Compared with sitagliptin, over mean 5.3 months, empagliflozin initiation decreased:
    • HHF-specific risk by 50% (HR, 0.50; 95% CI, 0.28-0.91), and
    • HHF-broad risk by 49% (0.51; 0.39-0.68).
  • Consistent results seen with addition of 100 more covariates (0.54; 0.29-0.98 for HHF-specific and 0.54; 0.41-0.71 for HHF-broad), stratification for follow-up duration, and in subgroup analyses by baseline CVD, HF history, sex, and empagliflozin dose.

Limitations

  • Residual confounding cannot be ruled out.
  • Possible outcome misclassification.
  • Short follow-up duration.
  • Small event number.