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Empagliflozin shows promise as add-on therapy
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Adults with type 2 diabetes inadequately controlled with the DPP-IV inhibitor linagliptin and metformin may achieve better glycemic control when the SGLT2 inhibitor empagliflozin is added on, study data show.
“The combination of linagliptin and empagliflozin in this study resulted in a potent glucose lowering with low risk of adverse events,” Eirik Søfteland, MD, PhD, of Haukeland University Hospital in Norway, told Endocrine Today. “The added benefit of weight loss is always welcome in our patients, and might — together with a single-pill fixed dose combination — aid in adherence to the therapy as well, which is a major issue in multiple oral therapies in diabetes.”
Søfteland and colleagues evaluated adults with type 2 diabetes (HbA1c, 7% to 10.5%) randomly assigned to empagliflozin (Jardiance, Boehringer Ingelheim) 10 mg (n = 112), empagliflozin 25 mg (n = 111) or placebo (n = 110) for 24 weeks while continuing treatment with metformin and linagliptin (Tradjenta, Boehringer Ingelheim) 5 mg. Researchers sought to determine the efficacy and safety of empagliflozin as add-on therapy.
Compared with placebo, empagliflozin led to greater reductions in mean HbA1c, mean fasting plasma glucose, and systolic and diastolic blood pressure from baseline to week 24. More participants assigned empagliflozin achieved HbA1c less than 7% compared with participants assigned to placebo.
Adverse events were less common among participants assigned empagliflozin (10 mg, 55.4%; 25 mg, 51.8%) compared with participants assigned placebo (68.2%).
“Even patients with high HbA1c near 9% can achieve treatment targets on this combination — together with metformin,” Søfteland told Endocrine Today. “The evidence base on three-drug combinations is not very strong, so this study demonstrated the clinically relevant efficacy and safety of the combination we tested. Looking forward, more studies are needed to decide the long-term efficacy and safety profile of this combination. Also, we got the very impressive results out of the EMPA-REG study earlier this year, which demonstrated the superiority of empagliflozin on cardiovascular outcomes and mortality. Of course, the Carolina trial, in which linagliptin is put to the test in a more low-CV risk population will be most interesting, and will also help clinicians in deciding which medications to combine in order to provide the best possible care for our type 2 diabetes patients.” – by Amber Cox
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Eirik Søfteland , MD, PhD, can be reached at esofteland@gmail.com.
Disclosure: Søfteland reports various financial ties with AstraZeneca, Boehringer Ingelheim, Eli Lilly and Company, Merck Sharpe and Dohme, Novartis, Novo Nordisk and Sanofi.
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