Impact of empagliflozin on insulin use in patients with heart failure with preserved ejection fraction (HFpEF) and type 2 diabetes: Sub-analysis from EMPEROR-Preserved trial
F. Logeaya (Mlle), F. Logeay*a (Mlle)
a Lilly France, Neuilly-Sur-Seine, FRANCE
T2DM is frequent among patients with heart failure with preserved ejection fraction (HFpEF), often requiring insulin therapy. We assessed the impact of empagliflozin on the need for insulin, and on clinical outcomes according to insulin use in the EMPEROR-Preserved trial.
Of the 5988 patients randomised to empagliflozin 10 mg or placebo, 49% had T2DM and 33% had preDM at baseline. We analysed the effects of empagliflozin vs placebo on time to first sustained insulin initiation (≥2 consecutive study visits) in T2DM/preDM patients . Further, we analysed the effect on the primary endpoint (first HHF or CV death), first HHF, total HHFs, and CV death in T2DM patients according to baseline subgroups of insulin use.
At baseline, 861 patients (434 in empagliflozin, 427 in placebo) were insulin-users. During a median period of 26 months, among T2DM/preDM patients not using insulin at baseline, empagliflozin reduced the risk of sustained insulin initiation by 31% (HR 0.69 [95% CI 0.49, 0.98], p=0.038). Among T2DM patients, insulin-usersat baseline had higher incidence rates of the primary endpoint, total HHFs and first HHF (p-values for comparison vsplacebo group: 0.0001,<0.0001,0.0002, respectively) that were reduced by empagliflozin but still remained higher than in the placebo arm of those not using insulin. .
In EMPEROR-Preserved, empagliflozin reduced the rate of insulin initiation by 31% in patients with HFpEF and T2DM/preDM. Insulin-users at baseline were at significantly higher risk of adverse CV-outcomes; still, the effects of empagliflozin on CV-outcomes were consistent in patients with T2DM irrespective of insulin treatment.
L’auteur a déclaré le(s) conflit(s) d’intérêt suivant(s) :
Employé à temps plein chez Lilly France