Key result
Empagliflozin and canagliflozin cut 3-point MACE ~14% vs. placebo in type 2 diabetes.
Why the study?
EMPA-REG and CANVAS trials assessed cardiovascular safety and benefits of empagliflozin and canagliflozin in type 2 diabetes patients with differing baseline CV risk and outcomes.
Hazard Ratio: 0.86 (95% CI 0.75–0.97)
Supports class effect of SGLT2 inhibitors on MACE in T2DM; leaves open optimal agent selection and broader applicability.
EMPA-REG OUTCOME and CANVAS trials were designed to study the cardiovascular safety of empagliflozin and canagliflozin, respectively. Both studies were sufficiently powered to study the non-inferiority for cardiovascular (CV) outcomes in patients with type 2 diabetes mellitus (DM) and showed superiority for major adverse cardiovascular events and composite renal outcomes independent of glycemic control. Further, all patients in EMPA-REG had prior CV events (secondary prevention), compared to CANVAS that also included subjects with no prior CV events, indicating the beneficial effects of canagliflozin in primary prevention of CV events as well. Moreover, there seems to be ethnic variations in response to sodium-glucose cotransporter 2 inhibitors (SGLT2i) regarding CV benefits, as Blacks fared better with canagliflozin and Asians with empagliflozin. Increases in lower extremity amputation and fracture incidence were observed with canagliflozin in CANVAS and this needs further substantiation, though these events were not systematically captured in the EMPA-REG study.
No takes yet. Share an insight, caveat, or question.
Rastogi et al. (2017) conducted a review in Type 2 diabetes mellitus with high cardiovascular risk (n=17,162). SGLT2 inhibitors (empagliflozin and canagliflozin) vs. Placebo was evaluated on Composite of 3-point Major Adverse Cardiovascular Events (3P-MACE: cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke) (HR 0.86, 95% CI 0.75-0.97). Both empagliflozin and canagliflozin demonstrated a 14% reduction (HR 0.86) in 3-point major adverse cardiovascular events compared to placebo in patients with type 2 diabetes mellitus.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: