Albuminuria Lowered with Empagliflozin in Diabetes, CVD Patients

Empagliflozin provides short- and long-term benefits to urinary albumin excretion, regardless of patients’ albuminuria status, according to the results of a recent randomized, double-blind, placebo-controlled trial.
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Previous research has shown that the sodium-glucose co-transporter-2 inhibitor empagliflozin reduced albuminuria in patients with type 2 diabetes and prevalent albuminuria. In a recent study, researchers examined the short- and long-term effects of empagliflozin on albuminuria in patients with both type 2 diabetes and cardiovascular disease.

The study, for which Boehringer Ingelheim & Eli Lilly and Company Diabetes Alliance provided funding, included 7028 participants with type 2 diabetes and cardiovascular disease. The participants were randomly assigned to empagliflozin 10 mg, empagliflozin 25 mg, or placebo in addition to standard care until at least 691 participants experienced an event included in the primary outcome.

Overall, 7020 participants received treatment. At baseline, urinary albumin-to-creatinine ratio (UACR) data was available for 6953 participants, 4171 of which had normoalbuminuria, 2013 of which had microalbuminuria, and 769 of which had macroalbuminuria.

Following short-term treatment at week 12, the placebo-adjusted geometric mean ratio of UACR change from baseline with empagliflozin was −7% in patients with normoalbuminuria, −25% in patients with microalbuminuria, and −32% in patients with macroalbuminuria.

Empagliflozin groups maintained reductions in UACR compared with placebo during long-term treatment, measured at 164 weeks. Following cessation of treatment for a median of 34 or 35 days, UACR was lower in the empagliflozin vs placebo group in those with baseline microalbuminuria or macroalbuminuria but not baseline normoalbuminuria.

Those participants treated with empagliflozin were more likely to experience sustained improvement from microalbuminuria to normoalbuminuria  or macroalbuminuria to microalbuminuria or normoalbuminuria.

“These results support short-term and long-term benefits of empagliflozin on urinary albumin excretion, irrespective of patients' albuminuria status at baseline,” the researchers concluded.

—Michael Potts

Reference:

Cherney DZ, Zinman B, Inzucchi SE, et al. Effects of empagliflozin on the urinary albumin-to-creatinine ratio in patients with type 2 diabetes and established cardiovascular disease: an exploratory analysis from the EMPA-REG OUTCOME randomised, placebo-controlled trial [published online June 2017). Lancet Diabetes & Endo. doi: http://dx.doi.org/10.1016/S2213-8587(17)30182-1