Christoph Wanner discusses the EMPA-REG study and the secondary kidney outcomes results.
FILMED AT THE EUROPEAN ASSOCIATION FOR THE STUDY OF DIABETES (EASD) ANNUAL MEETING, SEPTEMBER 2016
ONE YEAR ON FROM THE PUBLICATION OF THE EMPA-REG TRIAL, HOW HAS THE DATA BEEN TAKEN UP BY THE COMMUNITY AND HOW HAS THIS IMPACTED THE PATIENT?
00:15 - So, first of all, the data a year ago came as a surprise but also as a pleasure to many cardiologists, diabetologists, endocrinologists, first of all. They appreciated that they have now an instrument, a drug enhance, where for the first time in a decade or two decades, the community had an intervention in hand to save lives. You can say there was a 38% risk reduction in cardiovascular death. There was a 32% risk reduction in all-cause mortality. Overall, the intervention, empagliflozin, an SGLT2 inhibitor, reduced cardiovascular death and mortality, and this we didn’t see for so many years.
The cardiologists appreciated the finding because the study showed positive results in a type 2 diabetic with cardiovascular disease. So this is most prominent for them. On the other hand, all the patients are in the hands of diabetologists and general practitioners all over the place. And they, first of all, were looking after glucose control very intensively, and now shifting to cardiovascular outcome took some quite time. One year later, I think everybody has appreciated the full dataset and we can apply this beneficial effect to the patient.
HOW WILL THE RECENTLY PUBLISHED DATA ON KIDNEY OUTCOMES IMPACT ON CLINICAL PRACTICE?
02:19 – The kidney is a major target organ in type 2 diabetics, and many patients go to dialysis after about 18 years of type 2 diabetes due to uncontrolled blood sugar. So the nephrologists now saw that the principle of the intervention, which comes from the kidney going to the heart, also saves the kidney and reduces the progression of kidney disease towards dialysis. And the main results, very prominent result reduced kidney disease progression similar to cardiovascular outcomes by a very prominent 39% risk reduction. And if you go to more hard outcomes in the composite kidney outcome, a more hard outcome is doubling of serum creatinine, halving of kidney function, or even dialysis. If you go to these hard end points, the main finding was that you could really save patients from dialysis about 50% risk reduction, and the entire power of the intervention could be translated into one year of dialysis. You push patients and you push dialysis and you can save patients’ kidney function for one to two years with empagliflozin.
This was the most prominent result published about six weeks ago, and I think the kidney community now is taking up this and they are also thankful that, after 15 years without new intervention, we had the knowledge of blood pressure lowering and renin-angiotensin blockade before. But now, after 15 years, they have seen that a new powerful intervention can further delay progression of kidney disease, and I think this is so helpful for millions of patients out there with kidney disease moving towards the renal replacement therapy.
WHAT HAVE YOU FOUND MOST INTERESTING AT THIS YEAR’S EASD MEETING?
04:55 – If you understand that I’m a nephrologist, very interested in diabetic kidney disease, and coming now for the third time, not for my lifetime, to such a huge diabetes meeting; before, I visited nephrology meetings. I see here now everybody is talking about the new interventions saving lives. In the nephrologist community, we discuss saving kidneys but this is the same kidney; kidney death or kidney life. Here, they talk about cardiovascular outcomes and controlling blood glucose. So it’s a different world. I understand; I like to understand and this meeting is now, I think, full of major outcomes, not small surrogate outcomes, but looking at the big picture, saving cardiovascular outcome lives, and hopefully also saving kidneys in the future.