Empagliflozin improves renal outcomes in type 2 diabetes

The sodium-glucose cotransporter 2 inhibitor empagliflozin slows kidney disease progression in patients with type 2 diabetes at high cardiovascular risk, reports a study in The New England Journal of Medicine.

The study included 6185 patients with type 2 diabetes and eGFR of 30 mL/min per 1.73 m2 or higher enrolled in the EMPA-REG OUTCOME Trial. In that study, patients were randomly assigned to once daily treatment with empagliflozin (10 or 25 mg) or placebo. Previous results showed a significant reduction in major adverse cardiovascular events with empagliflozin.

The analysis focused on prespecified microvascular outcomes, particularly kidney disease progression. At a median of 3 years, rates of incident or worsening nephropathy were 12.7% for patients assigned to empagliflozin versus 18.8% in the placebo group (hazard ratio [HR], 0.61).

Doubling of serum creatinine occurred in 1.5% of patients receiving empagliflozin versus 2.6% with placebo (HR, 0.54). Rates of renal replacement therapy were 0.3 and 0.6%, respectively (HR, 0.45). Incident albuminuria was similar between groups. Adverse events were also similar between treatment groups in patients with or without impaired kidney function at baseline.

Added to standard treatment, empagliflozin reduces kidney disease progression and clinically relevant renal events in patients with type 2 diabetes at high cardiovascular risk. The researchers note that these outcomes were achieved in a patient sample with well controlled BP, including high use of renin-angiotensin-aldosterone system blockers [Wanner C, et al. Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med 2016, in press.