EMPEROR reduced – empagliflozin in patients with heart failure and reduced ejection fraction

Czech version

Authors: Jindřich Špinar; Lenka Špinarová; Jiří Vítovec
Authors‘ workplace: Lékařská fakulta Masarykovy univerzity Brno ; Interní kardio-angiologická klinika, Fakultní nemocnice u sv. Anny, Brno
Published in: Vnitř Lék 2021; 67(1): 43-47
Category:

Overview

Type 2 diabetes mellitus (T2DM) is common in patients with chronic heart failure and is associated with high morbidity and mortality. Significant advances have recently occured in the treatment of diabetes mellitus type 2 (T2DM) and cardiovascular diseases. Several new glucose lowering drugs have shown either neutral or positive cardiovascular effect especially on hospitalisations, but also on mortality. Some of these drugs have safety characteristics with strong practical implication in heart failure, for example sodium-glucose co-transporters type 2 inhibitors (SGLT-2). Position paper of the European Society of Cardiology/Heart Failure Association was published in October 2019 and in June 2020.

The results of EMPEROR reduced study were presented on European congress in september 2020. In this phase III, placebo-controlled trial, 3730 patients with New York Heart Association class II, III, or IV heart failure and an ejection fraction of 40% or less were randomly assigned to receive either empagliflozin (10 mg once daily) or placebo, in addition to recommended therapy. Over a median of 16 months, the primary outcome (cardiovascular mortality and hospitalisation for heart failure) occurred in 361 of 1863 patients (19.4%) in the empagliflozin group and in 462 of 1867 patients (24.7%) in the placebo group (hazard ratio, 0.75; 95% confidence interval [CI], 0.65 to 0.86; P<0.001). The effect of empagliflozin on the primary outcome was consistent in patients with and without diabetes and in those taking and not taking sacubitril/valsartan. The rate of decline in eGFR was slower in the empagliflozin group than in the placebo group (–0.2 ml/min/1.73m2/year vs –2.3 ml/min/1.73m2/year), P< 0.001,

Keywords:

SGLT2 inhibitors – empagliflozin – heart failure.

Sources

1. Lo KB, Gul F, Ram P, Kluger AY et al. The effects of SGLT2 inhibitors on cardiovascular and renal outcomes in diabetic patients: a systematic review and meta‑analysis. Cardiorenal Med. 2020; 10: 1–10.

2. Kato ET, Silverman MG, Mosenzon O, Zelniker TA et al. Effect of dapagliflozin on heart failure and mortality in type 2 diabetes mellitus. Circulation. 2019; 139: 2528–2536.

3. Neuen BL, Young T, Heerspink HJL, Neal B, Perkovic V et al. SGLT2 inhibitors for the prevention of kidney failure in patients with type 2 diabetes: a systematic review and meta‑analysis. Lancet Diabetes Endocrinol. 2019; 7: 845–854.

4. Packer M, Anker SD, Butler J et al. Cardiovascular and renal outcomes with empagliflozin in heart failure. NEJM 2020; DOI: 10.1056/NEJMoa2022190

5. Seferovic PM, Fragasso G, Petrie M et al. Sodiumglucose co‑transporter2 inhibitors in heart failure: beyond glycaemic control. A position paper of heart failure Association of the European Society of Cardiology. Eur J Heart Fail 2020; 22: 1495–1503, doi:10,1002/ejhf. 1954

6. Seferovic PM, Coats AJ, Ponikowski P et al. European Socety of Cardiology/ Heart Failure Association position paper on the role and safety new glucose lowering drugs in patients with heart failure. Eur J Heart Fail 2020; 22: 196–213, doi:10,1002/ejhf. 1673.

7. Špinar J, Hradec J, Špinarová L, Vítovec J. Summary of the 2016 ESC Guidelines on the diagnosis and treatment of acute and chronic heart failure. Prepared by the Czech Society of Cardiology. 2016; 58: 530–568.

8. Špinar J, Špinarová L, Vítovec J. Léčba diabetes mellitus u kardiovaskulárních onemocnění. Acta Medicinae 2019; 12: 48–53.

9. Špinar J, Špinarová L, Vítovec J. EMPEROR reduced – empagliflozin u nemocných se srdečním selháním a nízkou ejekční frakcí. Hypertenze a kardiovaskulární prevence 2020; 2: 62–66.

10. Táborský M, Linhart A, Špinar J et al. Inhibitory sodíko‑glukózového kotransportéru 2 při srdečním selhání: více než jen kontrola glykemie. Odborné stanovisko Asociace srdečního selhání Evropské kardiologické společnosti - souhrn dokumentu připravený ČKS. Cor et Vasa 2020; 62(5): 521–526. DOI: 10.33678/cor.2020.090.