Empagliflozin reduces cardiorenal events, healthcare resource use and mortality in Sweden compared to dipeptidyl peptidase‐4 inhibitors: Real world evidence from the NordicEMPRISEstudy

Abstract

Aims To evaluate effectiveness and healthcare resource utilization (HCRU) of empagliflozin versus dipeptidyl peptidase‐4 inhibitors (DPP‐4i) in Swedish clinical practice, as part of the EMPRISE EU study (EUPAS27606, NCT03817463). Materials and Methods A non‐interventional, cohort study using retrospectively collected data from Swedish national registries. Adults with type 2 diabetes newly initiated on empagliflozin or DPP‐4i from May 2014 to December 2018 were matched 1:1 using propensity scores based on >180 covariates. Cardiovascular outcomes included hospitalization for heart failure (HHF), all‐cause mortality (ACM), myocardial infarction (MI), stroke and cardiovascular mortality (CVM), as well as their composite outcomes. Renal outcomes included end‐stage renal disease (ESRD), estimated glomerular filtration rate (eGFR) decline to <60 ml/min/1.73 m2 and progression to micro/macroalbuminuria. HCRU outcomes were also assessed. Comparisons were done using Cox proportional hazards and Poisson regression models. Results Overall, 15,785 matched‐pairs were identified, with a mean follow‐up of 6.4 and 9.7 months for patients initiating empagliflozin versus DPP‐4i, respectively. Empagliflozin was associated with significant reduction in rates of HHF (hazard ratio [HR] = 0.67; 95% confidence interval: 0.49‐0.91), ACM (HR = 0.53; 0.41‐0.68), HHF + ACM (HR = 0.59; 0.48‐0.73), MI + stroke + ACM (HR = 0.68; 0.57‐0.81), CVM (HR = 0.46; 0.29‐0.73), HHF + CVM (HR = 0.61; 0.47‐0.79) and MI + stroke + CVM (HR = 0.79; 0.63‐0.98) versus DPP‐4i. Empagliflozin also reduced the rates of ESRD (HR = 0.13; 0.03‐0.57) and eGFR decline (HR = 0.83; 0.70‐0.99). Regarding HCRU, empagliflozin was associated with lower risk of first inpatient stay (HR = 0.87; 0.81‐0.93), and lower rate of inpatient and outpatient visits (rate ratio [RR] = 0.85; 0.80‐0.89 and RR = 0.96; 0.94‐0.98) than DPP‐4i. Conclusions Empagliflozin treatment compared to DPP‐4i reduced cardiorenal events and overall mortality, which may explain lower HCRU among empagliflozin users in Sweden.