The effectiveness of empagliflozin vs. DPP-4 inhibitors on cardiovascular outcomes and healthcare resource use in type 2 diabetes patients – Emprise real-world study

Background The effectiveness and healthcare resource utilization (HCRU) of empagliflozin vs dipeptidyl peptidase-4 inhibitors (DPP-4i) in Finnish clinical practice were compared, as part of the EU and Asian Emprise study (EUPAS27606, NCT03817463).

Methods Non-interventional, retrospective cohort study using data from Finnish national registries. Adults with type 2 diabetes starting empagliflozin or DPP-4i in May 2014 to December 2018 were matched 1:1 using propensity scores based on ≥170 variables. Cardiovascular (CV) and HCRU outcomes were compared using Cox proportional hazards and Poisson regression models.

Results In 11,801 matched patient pairs, empagliflozin was associated with a lower risk of hospitalization for heart failure (HHF) (HR=0.54; 95% CI: 0.39–0.74), all-cause mortality (ACM) (HR=0.36; 0.27–0.48), a composite of myocardial infarction (MI), stroke and ACM (HR=0.53; 0.43–0.66), CV mortality (HR=0.44; 0.30–0.65), and end-stage renal disease (ESRD) (HR=0.43; 0.19–0.95) compared with DPP-4i. A lower HCRU, i.e. 32% lower rate of inpatient visits (RR=0.68; 0.64–0.71), was also observed in users of empagliflozin. The results were similar regardless of CV disease history.

ConclusionsEmpagliflozin use was associated with a lower risk of CV events and lower HCRU compared with DPP-4i.

Leo Niskanen, Emilie Toresson-Grip, Joel Gunnarsson, Paula Casajust, Mikko Tuovinen, Lotta K. Stenman, Anastasia Ustyugova, Emprise Study Group

Leo Niskanen

M.D., Ph.D., Associate Professor, Specialist in Endocrinology and Internal Medicine

Päijät-Häme Central Hospital