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Cardiovascular Effectiveness of Empagliflozin vs. Glucagon-Like Peptide-1 Receptor Agonists or Liraglutide in the EMPRISE Study

The EMPRISE study is a real-world study that evaluated the effectiveness, safety, and healthcare utilization of empagliflozin in routine care. The EMPRISE program was initiated with the rationale to assess the beneficial effects of empagliflozin in routine clinical care in head-to-head comparisons with alternative glucose-lowering medications, specifically in patients with type 2 diabetes (T2D) patients without established cardiovascular disease.

Study Details

In the present analysis, the cardiovascular effectiveness of empagliflozin was compared with glucagon-like peptide 1 receptor agonists (GLP-1 RA) or liraglutide in patients with T2D in routine care with a broader spectrum of baseline cardiovascular risk.

Real-world data was collected using commercial insurance claims (Optum Clinformatics and IBM Marketscan) and US Medicare for a period of 5 years, from August 2014 to September 2019. The study populations included a cohort of T2D patients ≥18 years (≥65 years in Medicare) initiating empagliflozin or a GLP1-RA or liraglutide.

The study measured hospitalization for heart failure (HHF) in primary discharge position, myocardial infarction (MI), stroke, and all-cause mortality.

Study Results

After 1:1 propensity-score matching, a total of 260,816 patients on empagliflozin vs GLP- 1RA initiators and 166,548 patients on empagliflozin vs liraglutide initiators were identified. The patients were followed up for 8.9 months.

Compared to GLP-1RA, empagliflozin treatment was associated with a lower risk of HHF (HR, 0.70 [95% CI, 0.63-0.79]). The study saw a risk reduction for hospitalization for heart failure by about 30% and a similar risk of MI and stroke. The results were consistent for people with and without cardiovascular disease, however, the absolute benefits of empagliflozin were greater in patients with cardiovascular disease.

When empagliflozin was compared with liraglutide, the risk estimates were similar to those seen with GLP-1 receptor agonists.

Data from this study complements findings from the landmark EMPA-REG OUTCOME trial and highlights the beneficial effects of empagliflozin on cardiovascular outcomes regardless of baseline history of cardiovascular disease.