Empagliflozin efficacy, safety similar in Black, white patients with HF
The safety and efficacy of empagliflozin to treat HF was similar in Black and white patients, despite Black patients being at higher risk for HF, researchers reported.
“Our findings are limited by the relatively small number of Black patients and could be confounded by differences in baseline characteristics; hence this finding remains hypothesis generating. Efforts to recruit more Black patients in future trials are needed,” Subodh Verma, MD, PhD, FRCSC, professor and the Canada Research Chair in Cardiovascular Surgery at the University of Toronto, and colleagues wrote.
Verma and colleagues conducted a pooled analysis of 478 Black patients and 3,024 white patients from the EMPEROR-Reduced and EMPEROR-Preserved trials of empagliflozin (Jardiance, Boehringer Ingelheim/Eli Lilly).
Black and white patients had similar rates of HF in the preceding 12 months (Black, 22.6%; white 22.2%) as well as durations of HF (Black, 5.7 years; white, 5.4 years), the researchers wrote.
Compared with white patients, Black patients had higher rates of nonischemic HF etiologies (69.7% vs. 58.9%) and lower ejection fraction (39% vs. 42.9%), according to the researchers.
The primary outcome of CV death or HF hospitalization favored the empagliflozin group over the placebo group in Black patients (HR = 0.56; 95% CI, 0.38-0.81) and white patients (HR = 0.8; 95% CI, 0.68-0.95; P for interaction = .083), Verma and colleagues wrote, noting that in patients with HF with reduced ejection fraction, the treatment effect of empagliflozin for the primary outcome was greater in Black patients (HR = 0.44; 95% CI, 0.27-0.73) than in white patients (HR = 0.84; 95% CI, 0.66-1.06; P for interaction = .022), driven by time to first HF hospitalization.
In patients with HFrEF, but not patients with HF with preserved ejection fraction, the treatment effect of empagliflozin vs. placebo was greater for Black patients than white patients in the extended composite outcome of CV death, HF hospitalization and diuretic intensification (P for interaction = .015) and in Kansas City Cardiomyopathy Questionnaire overall summary score at 52 weeks (P for interaction = .043), according to the researchers.
“Black vs. white patients were at higher risk of HF events in EMPEROR Pooled. However, the efficacy and safety profile of empagliflozin is similar in Black and white patients with HF when assessed irrespective of EF, with a suggestion of potential enhanced efficacy in Black vs. white patients, particularly with HFrEF. Black patients may be predisposed to greater fluid retention and hence may derive more benefit from empagliflozin’s decongestive properties,” Verma and colleagues wrote.
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