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Kidney Week

Abstract: SA-PO480

Comparative Kidney and Cardiovascular Effectiveness of Empagliflozin Compared to Dipeptidyl Peptidase-4 Inhibitors in Patients with Type 2 Diabetes Mellitus

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Authors

  • Edmonston, Daniel, Duke Clinical Research Institute, Durham, North Carolina, United States
  • Mulder, Hillary, Duke Clinical Research Institute, Durham, North Carolina, United States
  • Lydon, Elizabeth, Duke Clinical Research Institute, Durham, North Carolina, United States
  • Chiswell, Karen, Duke Clinical Research Institute, Durham, North Carolina, United States
  • Lampron, Zachary, Duke Clinical Research Institute, Durham, North Carolina, United States
  • Shay, Christina M., Boehringer Ingelheim International GmbH, Ingelheim, Rheinland-Pfalz, Germany
  • Marsolo, Keith A., Duke Clinical Research Institute, Durham, North Carolina, United States
  • Bosworth, Hayden, Duke Clinical Research Institute, Durham, North Carolina, United States
  • Pagidipati, Neha, Duke Clinical Research Institute, Durham, North Carolina, United States
Background

Placebo-controlled trials of sodium-glucose cotransporter-2 inhibitors (SGLT2i) demonstrated kidney and cardiovascular benefit for people with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). We used real-world data to compare the effectiveness and safety of empagliflozin to dipeptidyl peptidase-4 inhibitors (DPP4i) in patients with T2DM, with and without CKD.

Methods

We used electronic health record data from 20 large US health systems participating in PCORnet©. Using propensity overlap weighting, we compared the effectiveness of empagliflozin vs. DPP4i in patients with T2DM among those newly prescribed these medications between 2016-2020. Primary composite endpoint included first occurrence of 40% eGFR decline, incident ESKD, or all-cause mortality (ACM) through 2 years. We also assessed cardiovascular and safety outcomes.

Results

Among 62,197 patients, 32% initiated empagliflozin and 68% initiated DPP4i. Median follow-up was 1.1 years. Empagliflozin was associated with lower risk of the primary outcome compared to DPP4i (Table). Risk for ACM and a cardiovascular composite of stroke, myocardial infarction, or ACM were also lower in patients prescribed empagliflozin overall and in those with CKD. The difference in heart failure hospitalization risk between groups did not reach statistical significance. Genital mycotic infections and diabetic ketoacidosis were the only safety events more common in patients prescribed empagliflozin. Differences in risk for primary composite, 40% eGFR decline and ACM were also significantly lower in patients with CKD.

Conclusion

In a real-world population with T2DM with and without CKD, empagliflozin is associated with significantly lower risk for kidney and cardiovascular outcomes compared with DPP4i.

Funding

  • Commercial Support – Boehringer Ingelheim and Lilly