Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
Quantify Research, Stockholm, Sweden.
Diabetes Obes Metab. 2023 Jan;25(1):261-271. doi: 10.1111/dom.14870. Epub 2022 Oct 10.
To evaluate effectiveness and healthcare resource utilization (HCRU) of empagliflozin versus dipeptidyl peptidase-4 inhibitors (DPP-4i) in Swedish clinical practice, as part of the EMPRISE EU study (EUPAS27606, NCT03817463).
A non-interventional, cohort study using retrospectively collected data from Swedish national registries. Adults with type 2 diabetes newly initiated on empagliflozin or DPP-4i from May 2014 to December 2018 were matched 1:1 using propensity scores based on >180 covariates. Cardiovascular outcomes included hospitalization for heart failure (HHF), all-cause mortality (ACM), myocardial infarction (MI), stroke and cardiovascular mortality (CVM), as well as their composite outcomes. Renal outcomes included end-stage renal disease (ESRD), estimated glomerular filtration rate (eGFR) decline to <60 ml/min/1.73 m and progression to micro/macroalbuminuria. HCRU outcomes were also assessed. Comparisons were done using Cox proportional hazards and Poisson regression models.
Overall, 15,785 matched-pairs were identified, with a mean follow-up of 6.4 and 9.7 months for patients initiating empagliflozin versus DPP-4i, respectively. Empagliflozin was associated with significant reduction in rates of HHF (hazard ratio [HR] = 0.67; 95% confidence interval: 0.49-0.91), ACM (HR = 0.53; 0.41-0.68), HHF + ACM (HR = 0.59; 0.48-0.73), MI + stroke + ACM (HR = 0.68; 0.57-0.81), CVM (HR = 0.46; 0.29-0.73), HHF + CVM (HR = 0.61; 0.47-0.79) and MI + stroke + CVM (HR = 0.79; 0.63-0.98) versus DPP-4i. Empagliflozin also reduced the rates of ESRD (HR = 0.13; 0.03-0.57) and eGFR decline (HR = 0.83; 0.70-0.99). Regarding HCRU, empagliflozin was associated with lower risk of first inpatient stay (HR = 0.87; 0.81-0.93), and lower rate of inpatient and outpatient visits (rate ratio [RR] = 0.85; 0.80-0.89 and RR = 0.96; 0.94-0.98) than DPP-4i.
Empagliflozin treatment compared to DPP-4i reduced cardiorenal events and overall mortality, which may explain lower HCRU among empagliflozin users in Sweden.
评估恩格列净与二肽基肽酶-4 抑制剂（DPP-4i）在瑞典临床实践中的疗效和医疗资源利用（HCRU），这是 EMPRISE EU 研究（EUPAS27606，NCT03817463）的一部分。
这是一项回顾性队列研究，使用瑞典全国登记处的数据，纳入 2014 年 5 月至 2018 年 12 月期间新开始接受恩格列净或 DPP-4i 治疗的 2 型糖尿病成人患者。基于 >180 个协变量，采用倾向评分进行 1:1 匹配。心血管结局包括心力衰竭（HHF）住院、全因死亡率（ACM）、心肌梗死（MI）、卒中和心血管死亡率（CVM），以及这些复合结局。肾脏结局包括终末期肾病（ESRD）、估算肾小球滤过率（eGFR）下降至 <60 ml/min/1.73 m2 和进展为微量/大量白蛋白尿。还评估了 HCRU 结局。使用 Cox 比例风险和泊松回归模型进行比较。
共纳入 15785 对匹配患者，分别接受恩格列净和 DPP-4i 治疗的患者平均随访 6.4 和 9.7 个月。与 DPP-4i 相比，恩格列净治疗显著降低了 HHF（风险比 [HR] = 0.67；95%置信区间：0.49-0.91）、ACM（HR = 0.53；0.41-0.68）、HHF+ACM（HR = 0.59；0.48-0.73）、MI+卒+ACM（HR = 0.68；0.57-0.81）、CVM（HR = 0.46；0.29-0.73）、HHF+CVM（HR = 0.61；0.47-0.79）和 MI+卒+CVM（HR = 0.79；0.63-0.98）的发生率。恩格列净还降低了 ESRD（HR = 0.13；0.03-0.57）和 eGFR 下降（HR = 0.83；0.70-0.99）的发生率。关于 HCRU，与 DPP-4i 相比，恩格列净治疗与首次住院的风险较低（HR = 0.87；0.81-0.93）和较低的住院和门诊就诊率（比率比 [RR] = 0.85；0.80-0.89 和 RR = 0.96；0.94-0.98）相关。
与 DPP-4i 相比，恩格列净治疗可降低心血管和肾脏事件及总体死亡率，这可能解释了瑞典恩格列净使用者的 HCRU 较低的原因。
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