Effectiveness and safety of empagliflozin in routine care patients: Results from the EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study.
Adult
Aged
Benzhydryl Compounds
Cardiovascular Diseases
/ complications
Cohort Studies
Diabetes Mellitus, Type 2
/ complications
Dipeptidyl-Peptidase IV Inhibitors
/ adverse effects
Glucosides
Humans
Medicare
Middle Aged
Myocardial Infarction
/ complications
Sodium-Glucose Transporter 2 Inhibitors
/ therapeutic use
Treatment Outcome
United States
cardiovascular outcomes
dipeptidyl peptidase-4 inhibitors
empagliflozin
safety outcomes
type 2 diabetes
Journal
Diabetes, obesity & metabolism
ISSN: 1463-1326
Titre abrégé: Diabetes Obes Metab
Pays: England
ID NLM: 100883645
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
revised:
20
10
2021
received:
16
06
2021
accepted:
31
10
2021
pubmed:
4
11
2021
medline:
31
3
2022
entrez:
3
11
2021
Statut:
ppublish
Résumé
To investigate effectiveness and safety outcomes among patients with type 2 diabetes (T2D) initiating empagliflozin versus dipeptidyl peptidase-4 (DPP-4) inhibitor treatment across the broad spectrum of cardiovascular risk. In a population-based cohort study we identified 39 072 pairs of 1:1 propensity score-matched adult patients with T2D initiating empagliflozin or DPP-4 inhibitors, using data from 2 US commercial insurance databases and Medicare between August 2014 and September 2017. The primary outcomes were a composite of myocardial infarction (MI)/stroke, and hospitalization for heart failure (HHF). Safety outcomes were bone fractures, lower-limb amputations (LLAs), diabetic ketoacidosis (DKA), and acute kidney injury (AKI). We estimated pooled hazard ratios (HRs) and 95% confidence intervals (CIs) adjusting for more than 140 baseline covariates. Study participants had a mean age of 60 years and only 28% had established cardiovascular disease. Compared to DPP-4 inhibitors, empagliflozin was associated with similar risk of MI/stroke (HR 0.99 [95% CI 0.81-1.21]), and lower risk of HHF (HR 0.48 [95% CI 0.35-0.67] and 0.63 [95% CI 0.54-0.74], based on a primary and any heart failure discharge diagnosis, respectively). The HR was 0.52 (95% CI 0.38-0.72) for all-cause mortality (ACM) and 0.83 (95% CI 0.70-0.98) for a composite of MI/stroke/ACM. Empagliflozin was associated with a similar risk of LLA and fractures, an increased risk of DKA (HR 1.71 [95% CI 1.08-2.71]) and a decreased risk of AKI (HR 0.60 [95% CI 0.43-0.85]). In clinical practice, the initiation of empagliflozin versus a DPP-4 inhibitor was associated with a lower risk of HHF, ACM and MI/stroke/ACM, a similar risk of MI/stroke, and a safety profile consistent with documented information.
Identifiants
pubmed: 34729891
doi: 10.1111/dom.14593
pmc: PMC8939295
mid: NIHMS1785414
doi:
Substances chimiques
Benzhydryl Compounds
0
Dipeptidyl-Peptidase IV Inhibitors
0
Glucosides
0
Sodium-Glucose Transporter 2 Inhibitors
0
empagliflozin
HDC1R2M35U
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
442-454Subventions
Organisme : NIA NIH HHS
ID : K08 AG055670
Pays : United States
Informations de copyright
© 2021 John Wiley & Sons Ltd.
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