1227-P: Cardiorenal Effectiveness of Empagliflozin vs. GLP-1 Receptor Agonists in Patients with Advanced Chronic Kidney Disease—Results from the EMPRISE Study

Abstract

Patients with chronic kidney disease (CKD) are at an increased risk of cardiovascular disease, heart failure, and mortality. We reported the final year results of the EMPRISE study program in patients with type 2 diabetes (T2D) and advanced CKD. Using Medicare, Optum, and Marketscan data (2014-19), we identified 10,930 pairs of 1:1 propensity score-matched patients aged >18 years with T2D and CKD stage 3-4 who initiated empagliflozin (EMPA) or a glucagon-like peptide-1 receptor agonist (GLP-1RA). Primary outcomes were hospitalization for heart failure (HHF), a composite of myocardial infarction (MI) or stroke, and end-stage renal disease (ESRD). Secondary outcomes were MI, stroke, and all-cause mortality. We estimated hazard ratios (HR) and rate differences (RD), adjusting for 143 baseline covariates. Compared to GLP-1RA, EMPA was associated with a reduced risk of HHF [HR 0.68 (0.55-0.85); RD -9.44 (-14.78, -4.10)], and ESRD [HR 0.70 (0.56-0.87); RD -9.01 (-14.30, -3.72)], and a trend towards reduced risk for the composite outcome [HR 0.88 (0.72-1.07); RD -3.84 (-9.60, 1.93)]. Estimates for the secondary outcomes were: MI [HR 0.78 (0.61-1.00)], stroke [HR 1.16 (0.83-1.62)], and all-cause mortality [HR 1.08 (0.86-1.36)]. In patients with T2D and advanced CKD in routine care, we observed risk reductions for cardiorenal outcomes with EMPA vs. GLP-1RA. Disclosure P.T.Htoo: Employee; Johnson & Johnson. E.Patorno: Research Support; Boehringer Ingelheim Inc., National Institutes of Health, Patient-Centered Outcomes Research Institute, US Food and Drug Administration. H.Tesfaye: None. D.J.Wexler: Other Relationship; Novo Nordisk A/S. R.Glynn: Research Support; Amarin Corporation, AstraZeneca, Kowa Pharmaceuticals America, Inc., Novartis, Pfizer Inc. N.Schmedt: Employee; Boehringer Ingelheim International GmbH. L.Koeneman: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. S.Schneeweiss: Consultant; Aetion, Inc., Research Support; UCB, Inc., Boehringer Ingelheim International GmbH, Stock/Shareholder; Aetion, Inc. J.M.Paik: None. Funding Boehringer Ingelheim (116283)