Empagliflozin shows cardiovascular benefits, slows kidney function decline
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For patients with heart failure, empagliflozin led to reduced risk for cardiovascular mortality and heart failure hospitalizations, while slowing kidney function decline regardless of chronic kidney disease status at baseline.
The findings, from phase 3 of the Emperor-Reduced trial, were presented virtually at ASN Kidney Week.
“On their own, heart failure and chronic kidney disease are each associated with an increased risk of hospitalizations and premature death from cardiovascular causes,” Faiez Zannad, MD, PhD, Emperor Program clinical investigator and emeritus professor of therapeutics at the University of Lorraine in France, said in a related press release. “The presence of one condition often accelerates the onset and progression of the other, further increasing this risk and leading to poorer prognoses.
“In Emperor-Reduced, empagliflozin demonstrated a consistent reduction in the risk of the composite primary endpoint of cardiovascular death and heart failure hospitalizations, while slowing kidney function decline, in adults with heart failure with reduced ejection fraction, with and without chronic kidney disease. This is promising news for the growing population of adults suffering from both heart failure and chronic kidney disease.”
For the study, researchers randomized 3,730 patients to either empagliflozin or placebo. Of the total study population, 53% had prevalent CKD (defined here as eGFR <60 mL/min/1.73m2 or an UACR >300 mg/g).
After a median follow-up of 16 months, Zannad and colleagues observed patients with prevalent CKD had a higher rate of both cardiovascular kidney events.
Regarding cardiovascular outcomes, researchers found empagliflozin reduced the risk of cardiovascular death and hospitalization for heart failure by 25%, while reducing total hospitalizations for heart failure by 30%.
When focusing specifically on kidney outcomes, they determined the drug reduced the composite of chronic dialysis, transplant and renal mortality by 50%, with researchers noting all three of these benefits were seen consistently in patients with and those without CKD at baseline. Patients with severe renal impairment (defined here as having an eGFR from 20 mL /min/1.73 m2 to 30 mL/min/1.73 m2) also experienced these benefits.
In addition, empagliflozin appeared to lower yearly loss of eGFR, regardless of baseline kidney function.
“Heart failure and chronic kidney disease are common, life-threatening diseases that require improved treatment options,” Jeff Emmick, MD, PhD, vice president of product development at Eli Lilly, said in the release. “The Empower clinical development program, including our ongoing Emperor-Preserved and EMPA-Kidney trials, explores the potential role Jardiance may play in improving outcomes for people with these conditions. The new findings from Emperor-Reduced will help us achieve our goal of redefining how people living with these conditions are treated.”
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Zannad F, et al. Paper FR-OR52. Presented at: ASN Kidney Week. Oct. 22-25, 2020 (virtual meeting).
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