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Kidney Week

Abstract: SA-PO266

Long-Term Use of Empagliflozin vs. DPP4 Inhibitors Mitigates eGFR Slopes in Patients With Type 2 Diabetes: Real-World Evidence

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Mosenzon, Ofri, Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Please Select, Israel
  • Melzer Cohen, Cheli, Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
  • Yanuv, Ilan, Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Please Select, Israel
  • Rozenberg, Aliza, Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Please Select, Israel
  • Chodick, Gabriel, Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
  • Schechter, Meir, Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Please Select, Israel
  • Karasik, Avraham, Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
Background

Randomized controlled studies showed that sodium–glucose cotransporter 2 inhibitors (SGLT2i) mitigate kidney function loss in patients with type 2 diabetes (T2D) at high cardiovascular (CV) and kidney risk. However, long-term efficacy studies in general population with T2D are lacking.

Methods

In Maccabi Healthcare Services, a large Israeli database (2015-2021), we compared the change in eGFR in patients with T2D who initiated empagliflozin (EMPA) or any SGLT2i, vs dipeptidyl peptidase-4 inhibitor (DPP4i). Treatment arms were propensity score-matched by 96 baseline characteristics. Subjects were followed until death, end of data availability, exposure discontinuation, initiation of the comparator drug, after 5 years, or October 2021. In a previous analysis we showed that compared to DPP4i, EMPA and any SGLT2i reduce the risk of the primary kidney outcome (≥40% eGFR declined or end-stage kidney disease). In this secondary analysis, we compared the change in eGFR overtime between arms.

Results

The matched population included overall 15992 initiators of EMPA or DPP4i (1:1 ratio), of them 12781 (79.9%) had eGFR measurement at follow-up. Median [IQR] follow-up was 17.9 [9.5-33.5] months, and 4924 (38.5%) were followed for ≥2 years. Mean eGFR slope were less steep with EMPA compared to DPP4i (-1.33 vs -2.26 mL/min/1.73m2/year) with mean absolute between-arms difference in favor of EMPA of 0.93 mL/min/1.73m2/year (95%CI 0.67-1.18; both p<0.001). Mitigation of eGFR slope with EMPA continued to increase with longer treatment (figure). Similar significant effects were obtained when comparing initiators of any SGLT2i to DPP4i.

Conclusion

Compared with DPP4i, long-term use of EMPA or any SGLT2i is associated with mitigation of kidney function loss in a general population with T2D.

Funding

  • Commercial Support