Abstract
Background: To compare the effects of empagliflozin and linagliptin use on kidney outcomes of type 2 diabetes mellitus (T2DM) patients in a real-world setting. Methods: The study involved a propensity score-matched cohort comprising new users of empagliflozin or linagliptin with T2DM between January 1, 2013 and December 31, 2018 from a large healthcare delivery system in Taiwan. Clinical outcomes assessed: acute kidney injury (AKI), post-AKI dialysis, and mortality. Cox proportional hazard model was used to estimate the relative risk of empagliflozin or linagliptin use; a linear mixed model was used to compare the average change in estimated glomerular filtration rate (eGFR) over time. Results: Of the 7,042 individuals, 67 of 3,521 (1.9%) in the empagliflozin group and 144 of 3,521 (4.1%) in the linagliptin group developed AKI during the 2 years follow-up. Patients in the empagliflozin group were at a 40% lower risk of developing AKI compared to those in the linagliptin group (adjusted hazard ratio [aHR], 0.60; 95% confidence interval [CI], 0.45–0.82, p = 0.001). Stratified analysis showed that empagliflozin users ≥65 years of age (aHR, 0.70; 95% CI, 0.43–1.13, p = 0.148), or with a baseline eGFR <60 ml/min/1.73 m2 (aHR, 0.97; 95% CI, 0.57–1.65, p = 0.899), or with a baseline glycohemoglobin ≦7% (aHR, 1.01; 95% CI, 0.51–2.00, p =0.973) experienced attenuated benefits with respect to AKI risk. A smaller decline in eGFR was observed in empagliflozin users compared to linagliptin users regardless of AKI occurrence (adjusted β = 1.51; 95% CI, 0.30–2.72 ml/min/1.73 m2, p = 0.014). Conclusion: Empagliflozin users were at a lower risk of developing AKI and exhibited a smaller eGFR decline than linagliptin users. Thus, empagliflozin may be a safer alternative to linagliptin for T2DM patients.
Highlights
Type 2 diabetes mellitus (T2DM) is a globally recognized critical health issue that generates a heavy economic burden on public health systems (Khan et al, 2020)
The studied cohort consisted of patients with 1) two or more codes of International Classification of Diseases, Nineth and Tenth Revision, Clinical Modification (ICD-9-CM, 250 and ICD-10-CM, E11, respectively) for T2DM with a minimum interval of 28 days from their last an outpatient setting or at least one inpatient claim, 2) at least one prescription of empagliflozin or linagliptin following the date of T2DM diagnosis between January 1, 2013, and December 31, 2018
The expense of glucose-lowering agents (GLAs) use was covered by Taiwan National Health Insurance program only when patients fulfill the diagnostic criteria of American Diabetes Association guideline (American Diabetes Association, 2020)
Summary
Type 2 diabetes mellitus (T2DM) is a globally recognized critical health issue that generates a heavy economic burden on public health systems (Khan et al, 2020). T2DM has been identified as an independent risk factor for acute kidney injury (AKI), which is associated with long-term negative effects on the renal system and higher mortality rates among hospitalized patients (Wang et al, 2012; Monseu el al., 2015). Large randomized clinical trials (RCTs) have shown that empagliflozin preserve long-term kidney function compared to placebo (Wanner et al, 2016; Wanner et al, 2018), there is limited information regarding the impact of empagliflozin on AKI risk and kidney function in the real-world setting (Nadkarni et al, 2017; Ueda et al, 2018; Cahn et al, 2019). To compare the effects of empagliflozin and linagliptin use on kidney outcomes of type 2 diabetes mellitus (T2DM) patients in a real-world setting
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