Clinician Insights

Empagliflozin's Mortality Benefit Boosts Prescribing


January 29, 2016

Attendees at a medical conference last year applauded over and over at the news that glucose-lowering empagliflozin (Jardiance, Boehringer Ingelheim/Lilly) also significantly reduced the relative risk for both cardiovascular mortality and all-cause mortality in patients with type 2 diabetes.

All that applause apparently has translated into major changes in how physicians treat such patients.

Almost two-thirds of physicians now say they are prescribing empagliflozin for more patients with diabetes, and roughly three-fourths intend to increase their prescribing of the drug, according to an online poll conducted by Medscape Medical News earlier this month. As of this morning, 619 physicians had taken the poll. Almost 61% of them identified themselves as endocrinologists.

The introduction to the poll summarized the findings of a study called the Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG). Presented at the European Association for the Study of Diabetes conference in Stockholm, Sweden, in September 2015 and published in the New England Journal of Medicine, the study demonstrated that a diabetes drug for the first time offered cardiac benefits besides reducing blood glucose.

The patients in the trial had type 2 diabetes and established cardiovascular disease. They were already being treated with ACE inhibitors, statins, and aspirin.

The EMPA-REG authors reported a 38% relative-risk reduction in cardiovascular mortality and a 32% relative-risk reduction in all-cause mortality for empagliflozin, compared with placebo.

Approved by the US Food and Drug Administration in August 2014, empagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor that lowers plasma glucose levels by increasing the amount of glucose excreted in urine. Other SGLT2 inhibitors are canagliflozin (Invokana, Janssen Pharmaceuticals) and dapagliflozin (Farxiga, AstraZeneca/BMS).

Endocrinologists Lead the Way

The Medscape poll on empagliflozin suggests that the EMPA-REG study has registered with most physicians. Seventy-eight percent said that before reading the introduction to the poll, they had either a fair, good, or very good understanding of the study's findings. And 76% agreed that the findings represented a significant advance in treating type 2 diabetes.

Lower Mortality, Higher Prescribing Rates

  All Physicians Family Physicians Internists Endocrinologists
Somewhat or strongly agree that EMPA-REG findings represent important advance in treating type 2 diabetes 76% 71% 71% 79%
Prescribing empagliflozin to more patients 65% 56% 52% 71%
Will increase empagliflozin prescribing in the future 74% 67% 70% 78%

Based on poll responses as of morning of January 29, 2016.

Increased prescribing of empagliflozin reported by 65% of physicians took different forms. Twenty-three percent had switched patients from either another SGLT-2 (7%) inhibitor or another diabetes drug class (16%) to empagliflozin. Forty-two percent had added empagliflozin to a patient's drug regimen.

Endocrinologists were more likely to have increased their empagliflozin prescribing (79%) than family physicians (56%) and internists (52%). Then again, endocrinologists were more likely to say they had understood the EMPA-REG study (88%), and that they considered it a major advance (79%).

Seventy-eight percent of endocrinologists said they would boost their empagliflozin prescribing and 22% planned to do it soon or very soon, in both cases topping their peers. At the other end of the spectrum were family physicians. Only 67% saw themselves prescribing more of the drug, and only 8% intended to do so soon or very soon.

Some reader comments on the poll reflected this go-slow approach.

"Interesting outcome, yet we don't know what will happen post-marketing," wrote one physician. "Early to get our hopes too high."


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