Cardiovascular effectiveness of empagliflozin vs. glucagon-like peptide-1 receptor agonists or liraglutide in the EMPRISE study

Question How does the cardiovascular effectiveness of empagliflozin compare to the one from glucagon-like peptide-1 receptor agonists or liraglutide in a real-world US population?

Methodology Within the EMPRISE®​ monitoring program, we evaluated the cardiovascular effectiveness of empagliflozin (EMPA) vs. glucagon-like peptide-1 receptor agonists (GLP1RA) or liraglutide using data from Medicare and 2 U.S. commercial claims databases [2014-19 (2018 for Medicare)]. We identified patients ≥ 18 years with type 2 diabetes initiating (i) EMPA vs GLP1-RA or (ii) EMPA vs liraglutide. Primary outcomes were hospitalization for heart failure (HHF), myocardial infarction (MI), stroke, and all-cause mortality (Medicare only). After 1:1 propensity score matching, we estimated pooled HR (95% CI) overall and in subgroups of patients with and without baseline cardiovascular disease (CVD).

Results We identified 105,955 pairs of EMPA vs. GLP1RA initiators and 72,498 pairs of EMPA vs. liraglutide initiators. Relative to GLP1RA, EMPA had a lower risk of HHF [HR:0.62 (95% CI, 0.53, 0.71)] and a similar risk of MI [0.95 (0.85, 1.07)], stroke [1.09 (0.94, 1.27)], and mortality [0.91 (0.77, 1.08)]. Results were consistent for patients with and without CVD. When we compared EMPA vs liraglutide, estimates were similar to those from GLP1 RA, both overall and across subgroups.

Conclusions Among real-world patients, EMPA was associated with a reduced risk of HHF, but with similar risk of MI, stroke, and mortality, across the broad spectrum of CVD, compared with GLP-1RA overall or liraglutide.

Publication History

Article published online:
02 May 2023