Long-Term Use of Empagliflozin Critical for Kidney Health, Study Finds
SAN DIEGO — A recent study presented at the American Society of Nephrology (ASN) Kidney Week 2024 revealed that the kidney and cardiovascular benefits associated with empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, for individuals with chronic kidney disease (CKD) are significantly reduced within a year after treatment discontinuation. This highlights the importance of maintaining ongoing treatment to fully realize its therapeutic advantages.
Key Findings of the EMPA-KIDNEY Trial
Carried out by Dr. William G. Herrington and his team from the University of Oxford, the study was published concurrently in the New England Journal of Medicine. It builds on findings from the EMPA-KIDNEY trial, where empagliflozin demonstrated a remarkable ability to lower the risk of kidney disease progression across diverse causes and stages of the condition. The trial was stopped early after an interim analysis revealed substantial efficacy.
To further explore the drug’s long-term effects post-treatment, researchers assessed data from 4,891 of the 6,609 active trial participants with CKD who participated in an additional two-year observational phase. Eligible patients were adults with an estimated glomerular filtration rate (eGFR) between 20 to 90 mL/min/1.73 m².
Study Demographics and Methodology
The post-trial analysis included individuals with a mean age of 63 years, with 34% being female. Notably, about 57% had no prior diagnosis of diabetes. Both groups had a mean eGFR of 37 mL/min/1.73 m², and around 35% had an eGFR of less than 30 mL/min/1.73 m².
Participants were randomized to receive either empagliflozin (10 mg daily) or a matching placebo. Importantly, the lack of significant differences in SGLT2 inhibitor usage after the trial allowed the researchers to accurately assess any carry-over effects of empagliflozin on clinical outcomes.
Outcomes of the Study
The primary composite outcome—encompassing kidney disease progression and cardiovascular death—was seen in 26.2% of patients receiving empagliflozin compared to 30.3% in the placebo group, demonstrating a hazard ratio of 0.79. However, during the post-trial period alone, the hazard ratio for this outcome decreased to 0.87, with statistical significance persisting but at a reduced level (P = .04).
Additional findings indicated that:
- Risk of kidney disease progression was 23.5% for empagliflozin users and 27.1% for placebo users.
- The composite risk of death or end-stage kidney disease was lower in the empagliflozin group (16.9% vs. 19.6%).
- The incidence of cardiovascular death was 3.8% for empagliflozin compared to 4.9% for the placebo group.
Overall, the initial 28% reduction in risk seen during active treatment decreased to a 13% reduction post-treatment, highlighting a temporary benefit that lasted about 12 months after discontinuation.
Expert Commentary
Dr. Emily Chang, an associate professor at the University of North Carolina, emphasized the importance of keeping patients on empagliflozin as a continuous treatment. She noted, "These are likely lifelong drugs… if a patient cannot tolerate it, this will limit use of the medicine. Otherwise, if tolerated, my plan is to leave these patients on this medicine lifelong."
This study underscores the necessity of ongoing treatment for CKD patients to maximize the benefits of SGLT2 inhibitors like empagliflozin. The findings suggest that healthcare providers need to consider long-term prescribing strategies and patient management to prolong the positive effects of these medications.
Implications for CKD Management
As the prevalence of chronic kidney disease continues to rise, understanding the long-term therapeutic landscape of SGLT2 inhibitors becomes increasingly critical. Clinicians are encouraged to remain vigilant about the potential for diminished benefits following treatment cessation. Regular monitoring of kidney function and cardiovascular health remains essential in managing CKD effectively.
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By staying informed and engaged with the latest research findings, healthcare professionals can provide optimal care and enhance patient outcomes. We encourage readers to share their thoughts or experiences regarding the management of chronic kidney disease in the comments section below.
