EMPA-REG analysis backs empagliflozin renoprotective effects
medwireNews: Further analysis of the EMPA-REG trial shows that treatment with empagliflozin improves urinary albumin excretion in patients with type 2 diabetes over the short and long term.
The effects were apparent regardless of patients’ baseline albuminuria status but, notably, were most marked in those with micro or macroalbuminuria, David Cherney (University of Toronto, Ontario, Canada) and co-researchers report in The Lancet Diabetes & Endocrinology.
In patients with normoalbuminuria at baseline, the urinary albumin-to-creatinine ratio (UACR) fell by a significant 7% during the first 12 weeks of treatment in those taking empagliflozin versus placebo. Over the next 3.1 years of follow-up, UACR rose gradually in both treatment groups, but to a lesser extent in the empagliflozin group, leading to an eventual 12% difference favoring empagliflozin.
This protective effect in favor of empagliflozin was more marked in patients with microalbuminuria and macroalbuminuria, with differences of 25% and 32%, respectively, at week 12, and of 30% and 32% at the end of follow-up. In these patients, the effects of empagliflozin on UACR were almost completely independent of changes in variables including glycated hemoglobin, blood pressure, weight, and kidney function, the team notes.
The analysis involved 6953 patients with baseline UACR data, of whom 59% had normoalbuminuria, 29% had microalbuminuria, and 11% had macroalbuminuria. Empagliflozin treatment significantly improved their chances of moving to a less severe UACR category (eg, from macro to micro or normoalbuminuria) during follow-up.
Among patients with micro or macroalbuminuria, the protective effect of empagliflozin persisted after the end of the treatment period. The difference in UACR between patients treated with empagliflozin versus placebo was around 45% at the last on-treatment measurement and around 25% about 35 days after the patients had stopped taking the study medications.
Marcel Muskiet (VU University Medical Center, Amsterdam, the Netherlands) and co-authors of an accompanying commentary suggest that this persistent effect could reflect “improvement of diabetes-related structural changes in the kidney with empagliflozin.”
They caution that it is too soon to say if sodium-glucose co-transporter (SGLT)2 inhibitors are indicated for renoprotection, but add: “Nevertheless, the available evidence is likely to encourage physicians to use empagliflozin more regularly in albuminuric patients with type 2 diabetes, taking into account the clinical contexts, adverse effects, costs, and cautions associated with SGLT2 inhibitors.”
The commentators say that forthcoming results from other SGLT2 inhibitor trials “will further inform whether SGLT2 inhibition is indeed the long-awaited dawn of a new era in renoprotective medicine.”
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