Empagliflozin gains occur on top of neprilysin inhibitor benefits in HF
medwireNews: Findings from EMPEROR-Reduced show that people with heart failure (HF) benefit from sodium-glucose cotransporter (SGLT)2 inhibition even if they are already taking a neprilysin inhibitor.
Of the 3730 people with HF (with or without diabetes) recruited to the trial, 19.5% were taking sacubitril or valsartan at baseline.
These participants achieved a significant 36% reduction in the risk for cardiovascular death or hospitalization for HF if they were taking empagliflozin rather than placebo. The corresponding risk reduction for those not receiving a neprilysin inhibitor was 23%.
The results were similar for the total number of HF hospitalizations and for decline in kidney function, with people receiving neprilysin inhibitors achieving numerically but not statistically larger reductions than those not taking them.
“The ability of empagliflozin to produce both cardiac and renal benefits in patients receiving sacubitril/valsartan is particularly noteworthy since patients receiving the neprilysin inhibitor were exceptionally well-treated with currently recommended drugs and devices,” write the researchers in the European Heart Journal.
Milton Packer (Baylor University Medical Center, Dallas, Texas, USA) and study co-authors note that their findings are in line with those from DAPA-HF, but based on a larger proportion of study participants taking neprilysin inhibitors and a higher rate of endpoint events.
They add: “The lack of an adverse interaction between SGLT2 inhibitors and sacubitril/valsartan reinforces the current belief that these two classes of drugs have distinctly different mechanisms of action.”
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