Treatment outcomes of graded dose of empagliflozin in type-2 diabetes: A real world study

Abstract

Background: Costs are important cause of therapeutic noncompliance in type-2 diabetes mellitus (T2DM). Half-tablet empagliflozin (EMPA)-25 mg has lowest monthly cost among all EMPA preparations; data is unavailable on efficacy of half EMPA-25. This study compared real world weight loss and glycaemic outcomes of 10 mg versus 12.5 mg versus 25 mg of EMPA. Methods: Data, retrospectively captured from records of 2 different centresfor patients > 35 years-age having T2DM on EMPA as part of standard pharmacotherapy for T2DM, having > 6 months follow-up data available was analysed. Patients were in 3-groups depending on EMPA dosage: Group 1 on EMPA 10 mg/day (1-tablet EMPA-10), Group-2 on EMPA 12.5 mg/day (half-tablet EMPA-25), and Group 3 on EMPA 25 mg/day (1-tablet EMPA-25). Primary endpoints were glycaemic efficacy and weight-loss. Results: Of 3601 records screened, data from 599 patients (184, 239 and 176 in Group-1, 2 and 3 respectively) was analysed. All 3 groups were comparable with regards to sex, blood pressure, haemoglobin, renal function, medications use. Group-3 were significantly older, had longest diabetes duration, highest HbA1c and lowest body mass index. Glycaemic efficacy was comparable among groups (ΔHbA1c Groups 1-3: −0.9 (−1.9 – 0.0), −1.0 (−1.8 – 0.5) and − 1.0 (−1.5 – 0.22], respectively; P = 0.363). Patients on EMPA 12.5 or 25 mg/d had significantly higher total (−1.4 [−3.0 –0.2] vs. −0.3 [−2.4 – 1.32] kg; P = 0.028) and percent weight-loss (−1.75% [−4.15 – 0.26] vs. −0.44% [−3.11 – 1.39]; P = 0.039), and significantly higherfraction achieving HbA1c < 5.7% (12% vs. 0; P = 0.021), compared to EMPA-10. Conclusion: Half EMPA-25 is the most cost effective way of using EMPA in clinical practice.

Comparative Assessment of the Long-Term Effectiveness and Safety of Dapagliflozin and Empagliflozin as Add-on Therapy to Hypoglycemic Drugs in Patients with Type 2 Diabetes

“…A study by Reifsnider et al demonstrated that EPG was a more cost-effective treatment than DPG and canagliflozin in patients with T2D and established cardiovascular disease (CVD) [ 21 ]. Dutta et al compared EPG 10 mg, 12.5 mg (half EPG 25), and 25 mg for their efficacy in lowering blood glucose (−0.9, −1.0, −1.0; P = 0.363) and suggested that half a tablet of EPG-25 is the most cost-effective method when using EPG [ 22 ]. Our results showed no difference in the effects of the SGLT2i analogs (DPG or EPG) and their dosages (one pill or half a pill) on blood glucose, blood pressure, and BW; however, our findings did not provide sufficient evidence for long-term cardiovascular benefits, and therefore, more evidence from a large randomized controlled trial is needed.…”

A Comparative Study on the Efficacy and Safety of Dose Escalation of Luseogliflozin in Type 2 Diabetes Mellitus Patients With Poor Glycemic Control

“…SGLT2 inhibitors that can be prescribed in higher doses in Japan include luseogliflozin, empagliflozin, dapagliflozin, and ipragliflozin. While the overall benefit of canagliflozin, dapagliflozin, and empagliflozin was found to be dose-dependent in a metaanalysis [5], and a retrospective study of empagliflozin showed an increase in dose [6], another metaanalysis [7] has reported that higher doses were as effective as regular doses; hence, it remains unclear whether the effects of SGLT2 inhibitors are dose-dependent. Among SGLT2 inhibitors, luseogliflozin (LUSEO) is a drug used at a minimum dose of 2.5 mg/day, which can be increased to 5 mg/day.…”