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EMPA-REG Outcome: Empagliflozin reduces kidney events in HF
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Patients with and without HF at baseline who were treated with empagliflozin had a decreased risk for clinically relevant kidney events compared with those assigned placebo, according to new data from the EMPA-REG Outcome trial presented at Heart Failure 2018 & World Congress on Acute Heart Failure.
“The renal-protective effects were observed on a background of standard of care and were consistent with those reported for the overall study population and included a significant majority of the patients on [ACE inhibitors or angiotensin receptor blockers],” Javed Butler, MD, MPH, MBA, FACC, FAHA, Patrick A. Lehan Professor and chairman of the department of medicine at the University of Mississippi and Cardiology Today Editorial Board Member, said during the presentation.
Kidney outcomes
In the present study, researchers assessed post-hoc kidney outcomes in patients with and without HF from the EMPA-REG Outcome trial.
As Cardiology Today and Endocrine Today previously reported, the sodium-glucose cotransporter 2 inhibitor empagliflozin (Jardiance, Boehringer Ingelheim) significantly reduced the risk for CV death and all-cause mortality in patients with type 2 diabetes and a history of CVD, in addition to reducing the risk for HF hospitalization or CV death and other HF-related endpoints. The EMPA-REG Outcome trial also found that patients with peripheral artery disease at baseline who were treated with empagliflozin had reduced risk for mortality, CV events, HF hospitalization and incident or worsening nephropathy compared with placebo, with no increase in risk for lower-limb amputation.
Among the cohort of 7,020 patients, 10.1% had HF.
The absolute risk for incidence or worsening nephropathy or CV death was increased in patients with HF at baseline compared with patients without HF (23.3% vs. 15.4%). The RR reduction with empagliflozin, however, was similar in both patients with (HR = 0.57; 95% CI, 0.42-0.77) and without HF (HR = 0.62; 95% CI, 0.55-0.7), according to the presentation.
When assessing the risk for only incident or worsening nephropathy, similar results were seen in patients with HF (HR = 0.53; 95% CI, 0.36-0.77) vs. those without HF (HR = 0.62; 95% CI, 0.54-0.71).
Results were similar in the risk for progression to macroalbuminuria, according to the presentation.
Empagliflozin and renal function
Compared with patients assigned placebo, kidney function based on estimated glomerular filtration rate declined in patients with and without HF when empagliflozin was first initiated, but then renal function was preserved in these patients over time.
Patients with HF and either normal or microalbuminuria at baseline who were assigned empagliflozin had a substantial reduction in events compared with those assigned placebo. Results were similar in patients without HF at baseline who were assigned empagliflozin, according to the presentation.
“Ongoing trials are further investigating the effects of empagliflozin in patients with heart failure with and without type 2 diabetes mellitus and in chronic kidney disease,” Butler said during the presentation. – by Darlene Dobkowski
Reference:
Butler J, et al. Abstract 1541. Presented at: Heart Failure 2018 & World Congress on Acute Heart Failure; May 26-29, 2018; Vienna.
Disclosures: EMPA-REG Outcome was funded by Boehringer Ingelheim. Butler reports he is a consultant for Amgen, Array, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, CVRx, G3 Pharmaceutical, Innolife, Janssen, Luitpold, Medtronic, Novartis, Relypsa, StealthPeptide, SC Pharma, Vifor and ZS Pharma.