Phase II Trials
In a Phase II, randomized, double-blind, placebo-controlled clinical trial, the safety, efficacy, tolerability, and PK of empagliflozin were evaluated in patients with T2DM [
32]. The investigators randomized 408 patients (treatment-naïve or having completed a 4-week washout) to empagliflozin (5, 10, or 25 mg once daily), placebo, or open-label metformin for 12 weeks. At baseline, the mean ± standard deviation (SD) HbA1c level across all groups was 7.9 ± 0.8%. After 12 weeks, dose-dependent reductions in HbA1c from baseline were seen in the empagliflozin-treated patients (5 mg −0.4%, 10 mg −0.5%, 25 mg −0.6%;
p < 0.0001 for all doses vs. placebo +0.1%). Patients in the open-label metformin arm had similar reductions in HbA1c levels of −0.7%, but the metformin arm was not designed to be tested for significance against the double-blind groups [
32].
Among the secondary endpoints, FPG levels also decreased with empagliflozin (5 mg −1.29 mmol/L, 10 mg −1.61 mmol/L, 25 mg −1.72 mmol/L; all doses
p < 0.0001 vs. placebo +0.04 mmol/L). Of special significance to patients with T2DM, who tend to be either overweight or obese, there were modest but significant decreases in body weight in each of the empagliflozin-treated groups, with changes from baseline of −1.81 kg, −2.33 kg, and −2.03 kg in the 5, 10, and 25-mg groups, respectively (all
p < 0.001 vs. placebo); the open-label metformin group had a −1.32 kg decrease versus baseline [
32].
The groups had similar rates of AEs, at 32.9% for the placebo group and 29.1% across the empagliflozin groups. Few differences between groups were observed for the most common AEs reported with empagliflozin; these were pollakiuria (3.3% vs. 0% for placebo), thirst (3.3% vs. 0% for placebo), and nasopharyngitis (2.0% vs. 1.2% for placebo) [
32]. There were AEs considered consistent with urinary tract infections (UTIs) in 4/244 patients (1.6%) on empagliflozin and 1/82 patients (1.2%) on placebo. Genital infections were reported in five patients (2%) on empagliflozin versus none on placebo. No patients discontinued due to UTIs or genital infections [
32].
A second Phase II study was undertaken to evaluate the efficacy and safety of empagliflozin as an add-on therapy to metformin. The investigators randomized 495 patients with T2DM who were inadequately controlled on metformin (HbA1c >7% to ≤10%) to double-blind empagliflozin (1, 5, 10, 25, or 50 mg once daily) or placebo, or to open-label sitagliptin 100 mg once daily, in addition to metformin for 12 weeks [
33]. At baseline (while on stable metformin), mean HbA1c across the seven groups ranged from 7.8 to 8.1%. After 12 weeks, mean HbA1c increased by 0.15% in the placebo group, compared with reductions of −0.1%, −0.2%, −0.6%, −0.6%, and −0.5% with empagliflozin 1, 5, 10, 25, or 50 mg, respectively, once daily (all were significant with the exception of 1 mg empagliflozin) [
33]. In addition, empagliflozin doses of 5–50 mg significantly reduced FPG levels at 12 weeks, with mean reductions of −2 to −28 mg/dL compared with an increase of 5 mg/dL with placebo (all
p < 0.0001). Empagliflozin was also associated with body weight reductions after 12 weeks (−2.3 to −2.9 kg with empagliflozin 5–50 mg vs. −1.2 kg with placebo;
p < 0.01) [
33].
In this study, empagliflozin was generally well tolerated, and reported frequencies of AEs were similar in the three main treatment groups: empagliflozin (29.6–48.6%), placebo (36.6%), and sitagliptin (35.2%), and the reported rates of hypoglycemia were low and balanced among the groups. The most frequent AEs were UTIs (4.0% vs. 2.8%; empagliflozin vs. placebo) and pollakiuria (2.5% vs. 1.4%; empagliflozin vs. placebo). Genital infections (4.0%) were reported only in the empagliflozin-treated patients [
33].
In these Phase II studies, empagliflozin treatment led to dose-dependent, clinically meaningful reductions in HbA1c and FPG, along with concomitant reductions in body weight compared with placebo-treated patients after 12 weeks, indicating empagliflozin can be efficacious as monotherapy or as add-on therapy for patients with T2DM who are not meeting their treatment goals on metformin alone.
Phase III Trials
The Phase III clinical trial program evaluating empagliflozin in patients with T2DM reportedly includes more than 10 multinational trials, between them enrolling more than 14,500 patients, including patients across a wide age range and with a diversity of concomitant diseases [
37]. At the time of writing, three Phase III trials have been published in detail, and are reviewed below.
In the first of these Phase III trials, the efficacy and safety of empagliflozin monotherapy was investigated in a randomized, placebo-controlled study of patients with T2DM with HbA1c levels of 7–10% who were treatment-naïve or had not received medication over the 12 weeks preceding the trial [
34]. Patients were randomized to empagliflozin 10 mg (
n = 224), empagliflozin 25 mg (
n = 224), placebo (
n = 228), or sitagliptin 100 mg (
n = 223) once daily [
34]. Patients with HbA1c >10% at screening were not randomized, but were assigned open-label empagliflozin 25 mg for 24 weeks (
n = 87).
At 24 weeks, the randomized empagliflozin groups had significant improvements in HbA1c, FPG, and body weight compared with placebo, as shown in Tables
3,
4, and
5 [
34]. Furthermore, patients randomized to empagliflozin were more likely to achieve an HbA1c target of <7.0% at week 24: among patients who had HbA1c levels ≥7.0% at baseline, 35% of the empagliflozin 10-mg group and 44% of the 25-mg group achieved HbA1c <7.0% compared with 12% of the placebo group (odds ratio for empagliflozin 10 mg vs. placebo: 4.12; 95% CI 2.44, 6.97;
p < 0.0001 and for empagliflozin 25 mg vs. placebo 6.15; 95% CI 3.65, 10.36;
p < 0.0001). Both empagliflozin groups also had significant reductions from baseline in systolic blood pressure versus placebo (empagliflozin 10 mg −2.6 mmHg; 95% CI −4.9, −0.4;
p = 0.0231; empagliflozin 25 mg −3.4 mmHg; 95% CI −5.7, −1.2;
p = 0.0028) [
34].
Table 3
Changes in HbA1c with empagliflozin in Phase III clinical trials
|
Empagliflozin 10 mg qd (n = 224) | 7.9 (0.9)a
| −0.74% (−0.88, −0.59; p < 0.0001) |
Empagliflozin 25 mg qd (n = 224) | 7.9 (0.9)a
| −0.85% (–0.99, −0.71; p < 0.0001) |
Sitagliptin 100 mg qd (n = 223) | 7.9 (0.8)a
| −0.73% (–0.88, −0.59; p < 0.0001) |
|
Empagliflozin 10 mg qd (n = 217) | 7.9 (0.1)b
| −0.57% (−0.70, −0.43; p < 0.001) |
Empagliflozin 25 mg qd (n = 213) | 7.9 (0.1)b
| −0.64% (−0.77, −0.50; p < 0.001) |
Add-on to metformin + sulfonylurea [ 35] |
Empagliflozin 10 mg qd (n = 225) | 8.1 (0.8)a
| −0.64% (−0.77, −0.51; p < 0.001) |
Empagliflozin 25 mg qd (n = 216) | 8.1 (0.8)a
| −0.59% (−0.73, –0.46; p < 0.001) |
Add-on to pioglitazone ± metformin [ 36] |
Empagliflozin 10 mg qd (n = 165) | 8.1 (0.9)a
| −0.48% (−0.66, −0.29; p < 0.001) |
Empagliflozin 25 mg qd (n = 168) | 8.1 (0.8)a
| −0.61% (−0.79, −0.42; p < 0.001) |
Table 4
Changes in fasting plasma glucose with empagliflozin in Phase III clinical trials
|
Empagliflozin 10 mg qd (n = 223) | 8.48 (1.79)a
| −1.73 (−2.03, −1.43; p < 0.0001)b
|
Empagliflozin 25 mg qd (n = 223) | 8.47 (1.89)a
| −2.01 (−2.31, −1.71; p < 0.0001)b
|
Sitagliptin 100 mg qd (n = 223) | 8.16 (1.60)a
| −1.04 (−1.34 to −0.73; p < 0.0001)b
|
|
Empagliflozin 10 mg qd (n = 217) | 8.60 (0.13)c
| −1.11 (0.10); p < 0.001 vs. placebod
|
Empagliflozin 25 mg qd (n = 213) | 8.29 (0.12)c
| −1.24 (0.10); p < 0.001 vs. placebod
|
Placebo (n = 207) | 8.66 (0.12)c
| +0.35 (0.10)d
|
Add-on to metformin + sulfonylurea [ 35] |
Empagliflozin 10 mg qd (n = 225) | 8.38 (1.82)a
| −1.60 (−1.90, −1.30; p < 0.001)b
|
Empagliflozin 25 mg qd (n = 216) | 8.69 (1.87)a
| −1.60 (−1.90, −1.29; p < 0.001)b
|
Add-on to pioglitazone ± metformin [ 36] |
Empagliflozin 10 mg qd (n = 165) | 8.44 (2.12)a
| −1.30 (−1.71, −0.90; p < 0.001)b
|
Empagliflozin 25 mg qd (n = 168) | 8.43 (2.05)a
| −1.58 (−1.98, −1.18; p < 0.001)b
|
Table 5
Changes in body weight with empagliflozin in Phase III clinical trials
|
Empagliflozin 10 mg qd (n = 224) | 78.4 (18.7)a
| −1.93 (−2.41, −1.45; p < 0.0001) |
Empagliflozin 25 mg qd (n = 224) | 77.8 (18.0)a
| −2.15 (−2.63, −1.67; p < 0.0001) |
Sitagliptin 100 mg qd (n = 223) | 79.3 (20.4)a
| +0.52 (0.04, 1.00; p < 0.0355) |
|
Empagliflozin 10 mg qd (n = 217) | 81.6 (1.3)b
| −1.63 (−2.11, −1.15; p < 0.001) |
Empagliflozin 25 mg qd (n = 213) | 82.2 (1.3)b
| −2.01 (−2.49, −1.53; p < 0.001) |
Add-on to metformin + sulfonylurea [ 35] |
Empagliflozin 10 mg qd (n = 225) | 77.1 (18.3)a
| −1.76 (−2.19, −1.34; p < 0.001) |
Empagliflozin 25 mg qd (n = 216) | 77.5 (18.8)a
| −1.99 (−2.42, −1.56; p < 0.001) |
Add-on to pioglitazone ± metformin [ 36] |
Empagliflozin 10 mg qd (n = 165) | 78.0 (19.1)a
| −1.95 (−2.55, −1.36; p < 0.001) |
Empagliflozin 25 mg qd (n = 168) | 78.9 (19.9)a
| −1.81 (−2.41, −1.22; p < 0.001) |
For patients assigned open-label empagliflozin, no formal statistical analyses were performed, but the investigators noted large reductions from baseline to 24 weeks in HbA1c (−3.7%; 95% CI −4.1, −3.3), with 28% of these patients reaching HbA1c <7.0% by week 24. The group also had large reductions in FPG (−4.86 mmol/L; 95% CI −5.55, −4.16), and mean changes in weight (−2.43 kg; 95% CI −3.50, −1.37) and systolic blood pressure (−4.0 mmHg; 95% CI −7.1, −0.9) of a similar level to changes in the empagliflozin 25-mg randomized group.
The majority of AEs were mild, with similar proportions reported in each treatment arm [placebo group, 140 (61%); empagliflozin 10 mg, 123 (55%); empagliflozin 25 mg, 135 (60%); and sitagliptin, 119 (53%)]. Serious AEs also occurred in similar proportions of patients [placebo group, 6 (3%); empagliflozin 10 mg, 8 (4%); empagliflozin 25 mg, 5 (2%); and sitagliptin, 6 (3%)] [
34]. The most common AE was hyperglycemia, which was reported in 35 (15%) placebo patients, five (2%) empagliflozin 10-mg patients, four (2%) empagliflozin 25-mg patients, and 13 (6%) sitagliptin patients. The second most common AE was nasopharyngitis, which was reported in 17 (7%) placebo patients, 16 (7%) empagliflozin 10-mg patients, 11 (5%) empagliflozin 25-mg patients, and 15 (7%) sitagliptin patients. Rates of hypoglycemia were <1% in all treatment groups [
34]. Laboratory measurements included serum lipids and plasma uric acid concentrations (Tables
6,
7). Of note, empagliflozin appeared to be associated with improvements in uric acid compared with placebo. In addition, compared with placebo, high-density lipoprotein (HDL)-cholesterol increased significantly from baseline in patients treated with empagliflozin 10 or 25 mg, but levels of total cholesterol, low-density lipoprotein (LDL)-cholesterol, or triglycerides did not change [
34].
Table 6
Changes in serum lipids with empagliflozin in Phase III clinical trials
|
Placebo (n = 228) | 5.03 (0.08) | 0.05 (0.05) | 1.26 (0.02) | 0.04 (0.01) | 2.90 (0.06) | 0.04 (0.04) | 2.01 (0.09) | −0.07 (0.10) |
Empagliflozin 10 mg qd (n = 224) | 5.00 (0.08) | 0.07 (0.05) | 1.24 (0.02) | 0.11 (0.01) | 2.86 (0.07) | 0.06 (0.04) | 2.08 (0.12) | −0.30 (0.10) |
Difference vs. placebo | 0.02 (0.07) p = 0.738 | 0.07 (0.02) p < 0.001 | 0.03 (0.06) p = 0.651 | −0.23 (0.14) p = 0.090 |
Empagliflozin 25 mg qd (n = 224) | 5.00 (0.08) | 0.15 (0.05) | 1.25 (0.02) | 0.13 (0.01) | 2.75 (0.07) | 0.11 (0.04) | 2.37 (0.20) | −0.18 (0.10) |
Difference vs. placebo | 0.11 (0.07) p = 0.143 | 0.09 (0.02) p < 0.001 | 0.07 (0.06) p = 0.258 | −0.11 (0.14) p = 0.408 |
Sitagliptin 100 mg qd (n = 223) | 4.95 (0.07) | 0.08 (0.05) | 1.26 (0.02) | 0.02 (0.01) | 2.74 (0.05) | 0.03 (0.04) | 2.20 (0.13) | 0.06 (0.10) |
Difference vs. placebo | 0.03 (0.07) p = 0.676 | −0.02 (0.02) p = 0.262 | −0.01 (0.06) p = 0.864 | 0.13 (0.14) p = 0.350 |
Add-on to metformin + sulfonylurea [ 35] a
|
Placebo (n = 225) | 4.40 (0.07) | 0.03 (0.04) | 1.25 (0.02) | −0.02 (0.01) | 2.39 (0.06) | 0.02 (0.04) | 1.70 (0.09) | 0.08 (0.09) |
Empagliflozin 10 mg qd (n = 225) | 4.42 (0.06) | 0.08 (0.04) | 1.26 (0.02) | 0.05 (0.01) | 2.35 (0.06) | 0.04 (0.04) | 1.87 (0.09) | 0.03 (0.09) |
Difference vs. placebo | 0.06 (0.06) p = 0.377 | 0.06 (0.02) p < 0.001 | 0.01 (0.05) p = 0.807 | −0.05 (0.12) p = 0.672 |
Empagliflozin 25 mg qd (n = 216) | 4.50 (0.07) | 0.20 (0.05) | 1.27 (0.02) | 0.05 (0.01) | 2.41 (0.06) | 0.10 (0.04) | 1.82 (0.07) | 0.17 (0.09) |
Difference vs. placebo | 0.17 (0.06) p = 0.007 | 0.07 (0.02) p < 0.001 | 0.08 (0.05) p = 0.131 | 0.09 (0.12) p = 0.459 |
Add-on to pioglitazone ± metformin [ 36] a
|
Placebo (n = 165) | 4.86 (0.09) | 0.00 (0.06) | 1.31 (0.02) | −0.01 (0.02) | 2.76 (0.08) | 0.00 (0.05) | 1.73 (0.06) | −0.01 (0.06) |
Empagliflozin 10 mg qd (n = 165) | 4.76 (0.09) | 0.06 (0.06) | 1.28 (0.02) | 0.04 (0.02) | 2.65 (0.08) | 0.09 (0.05) | 1.86 (0.14) | −0.18 (0.06) |
Difference vs. placebo | 0.06 (0.09) p = 0.489 | 0.06 (0.02) p = 0.012 | 0.09 (0.07) p = 0.234 | −0.17 (0.09) p = 0.070 |
Empagliflozin 25 mg qd (n = 168) | 4.69 (0.09) | 0.06 (0.06) | 1.31 (0.02) | 0.02 (0.02) | 2.60 (0.07) | 0.04 (0.05) | 1.76 (0.13) | 0.00 (0.06) |
Difference vs. placebo | 0.06 (0.09) p = 0.480 | 0.03 (0.02) p = 0.186 | 0.04 (0.07) p = 0.576 | 0.02 (0.09) p = 0.842 |
Table 7
Changes in plasma uric acid with empagliflozin in Phase III clinical trials
|
Empagliflozin 10 mg qd (n = 224) | 293 (109) | −58 (80) |
Empagliflozin 25 mg qd (n = 224) | 297 (124) | −62 (83) |
Sitagliptin 100 mg qd (n = 223) | 298 (114) | +17 (77) |
Placebo (n = 228) | 307 (133) | −14 (91) |
Add-on to metformin + sulfonylurea [ 35] |
Empagliflozin 10 mg qd (n = 225) | 314 (127) | −28 (87) |
Empagliflozin 25 mg qd (n = 216) | 298 (115) | −26 (81) |
Placebo (n = 225) | 307 (110) | +11 (81) |
Add-on to pioglitazone ± metformin [ 36] |
Empagliflozin 10 mg qd (n = 165) | 286 (116) | −37 (83) |
Empagliflozin 25 mg qd (n = 168) | 272 (116) | −29 (81) |
Placebo (n = 165) | 275 (113) | +13 (69) |
The safety and efficacy of empagliflozin as add-on therapy in patients with T2DM receiving metformin with or without a sulfonylurea was assessed in a randomized, double-blind Phase III trial; two sub-studies were defined by the patients’ background medication at screening. In the first part of the study, patients on metformin only were randomized to 24 weeks of double-blind treatment with either empagliflozin 10 mg (
n = 217) or 25 mg (
n = 213) once daily or placebo (
n = 207) [
38]. As with the previous trial, patients with HbA1c >10% at screening were not randomized, and instead were included in an open-label empagliflozin 25-mg arm (
n = 69).
Preliminary results have been presented, and support the use of empagliflozin as add-on treatment to metformin, with the empagliflozin groups having significant improvements in HbA1c, FPG, and body weight compared with placebo after 24 weeks (Tables
3,
4,
5) [
38]. Among patients who had HbA1c levels ≥7.0% at baseline, 13% of the placebo group achieved an HbA1c <7.0% by 24 weeks compared with 38% of the empagliflozin 10-mg group (odds ratio, 4.72;
p < 0.001 vs. placebo) and 39% of the empagliflozin 25-mg group (odds ratio, 4.67;
p < 0.001 vs. placebo). Of note, a weight loss of >5% of body weight was achieved by 4.8% of patients in the placebo arm after 24 weeks, compared with 21.2% on empagliflozin 10 mg, and 23.0% on empagliflozin 25 mg [
38]. The empagliflozin groups also had significant reductions in systolic blood pressure, with mean changes of −4.5 ± 0.7 mmHg in the 10-mg group and −5.2 ± 0.7 mmHg in the 25-mg group.
For the group of patients with very high HbA1c at screening, who were assigned open-label empagliflozin 25 mg in addition to their background metformin, HbA1c fell by a mean ± standard error (SE) of −3.2 ± 0.2% from a baseline mean of 11.1 ± 0.2%. Improvement was also seen in FPG, with a mean ± SE reduction of −3.02 ± 0.57 mmol/L, from a baseline mean of 11.30 ± 0.43 mmol/L. The group also had reductions from baseline in body weight (mean ± SE −1.91 ± 0.59 kg) and systolic blood pressure (mean ± SE −2.4 ± 1.6).
In this trial, AEs were reported by 57.1%, 49.5%, and 58.7% of patients on empagliflozin 10 mg, empagliflozin 25 mg, and placebo, respectively. Hypoglycemia (defined as plasma glucose ≤70 mg/dL, and/or requiring assistance) was reported in very low proportions of patients (1.8% in the empagliflozin 10-mg arm, 1.4% in the empagliflozin 25-mg arm, and 0.5% in the placebo arm), and none of the cases required assistance [
38]. AEs consistent with UTIs were reported in low proportions across the treatment arms (5.1%, 5.6%, and 4.9% in the empagliflozin 10-mg, 25-mg, and placebo arms, respectively). Rates of AEs associated with genital infection were also low with empagliflozin, but appeared more frequent than with placebo (3.7% and 4.7% in the 10-mg and 25-mg empagliflozin arms vs. none in patients receiving placebo) [
38].
In the second part of the study, patients with HbA1c inadequately controlled on metformin and a sulfonylurea were randomized to add on once-daily empagliflozin 10 mg (
n = 225), empagliflozin 25 mg (
n = 216), or placebo (
n = 225) for 24 weeks [
35]. Improvements were seen in glycemic control, with reductions in HbA1c levels after 24 weeks being significantly greater in the empagliflozin-treated groups, as were reductions in FPG and body weight, as shown in Tables
3,
4, and
5 [
35]. Patients were more likely to achieve HbA1c <7.0% with empagliflozin, with 26.3% of the empagliflozin 10-mg group reaching this goal (odds ratio vs. placebo 3.85; 95% CI 2.17, 6.85;
p < 0.001) and 32.2% in the empagliflozin 25-mg group (odds ratio vs. placebo 5.22; 95% CI 2.95, 9.24;
p < 0.001). The effects of 24 weeks of empagliflozin on body weight (Table
5) were consistent with earlier reports, with significant differences in the adjusted means for empagliflozin versus placebo [
35]. Reductions in blood pressure were of a similar level to those seen with empagliflozin used as monotherapy, with a placebo-corrected reduction in the empagliflozin 10-mg group of −2.7 mmHg (95% CI −4.6, −0.8;
p = 0.005) and in the 25-mg group of −2.1 (95% CI −4.0, −0.2;
p = 0.032).
In this study, 101 patients with HbA1c >10% at screening were treated with open-label empagliflozin 25 mg as add-on to stable metformin and sulfonylurea. The mean ± SE change from baseline in HbA1c at week 24 was −2.9 ± 0.2%, and the mean value fell from 11.2 ± 1.3% at baseline to 8.2 ± 0.1% at week 24. At week 24, the mean ± SE change from baseline in FPG was −3.02 ± 0.37 mmol/L, change in body weight was −1.76 ± 0.40 kg, and change in systolic blood pressure was −4.3 ± 1.2 mmHg.
AEs were reported at similar proportions across treatment groups, at 67.9% in the empagliflozin 10-mg group, 64.1% in the empagliflozin 25-mg group, and 62.7% in the placebo group [
35]. Events consistent with UTIs were reported in 10.3% and 8.3% of the empagliflozin 10-mg and 25-mg groups, respectively, versus 8.0% of the placebo group, while events consistent with genital infections were reported in 2.7% and 2.3% of the respective empagliflozin groups versus 0.9% of the placebo group [
35]. For LDL-cholesterol and triglycerides, there were no significant differences compared with placebo, while there was a small increase in HDL-cholesterol (Table
6). In the randomized empagliflozin groups, there were small decreases in uric acid (Table
7).
The third Phase III trial published is a randomized, double-blind, placebo-controlled trial that examined the efficacy and safety of empagliflozin in patients with T2DM who were on pioglitazone at screening; patients could also be receiving metformin [
36]. Patients were randomized and treated with once-daily empagliflozin 10 mg (
n = 165), 25 mg (
n = 168), or placebo (
n = 165) for 24 weeks [
36]. Unlike the aforementioned trials, the design of this study did not include an open-label arm for patients with very high HbA1c at screening.
The investigators found that 24 weeks of empagliflozin treatment resulted in significant reductions in HbA1c and FPG (Tables
3,
4), and more patients with HbA1c ≥7.0% at baseline achieved HbA1c <7.0% with empagliflozin 10 mg (23.8%) and 25 mg (30.0%) than with placebo (7.7%) (odds ratio for empagliflozin 10 mg vs. placebo: 3.85; 95% CI 1.88, 7.92;
p < 0.001; odds ratio for empagliflozin 25 mg vs. placebo: 5.02; 95% CI 2.49, 10.12;
p < 0.001). Empagliflozin was also associated with significant reductions in body weight (Table
5) and larger proportions of patients experienced reduction of >5% of body weight (18.8% and 13.7% of patients receiving 10 mg and 25 mg of empagliflozin, compared with 5.5% of patients receiving placebo). Empagliflozin was also associated with reductions in blood pressure compared with placebo: systolic blood pressure fell by −3.9 mmHg (95% CI −6.23, −1.50;
p = 0.001) with empagliflozin 10 mg and −4.7 mmHg (95% CI −7.08, −2.37;
p < 0.001) with empagliflozin 25 mg [
36].
In this study, as in previous studies, empagliflozin was well tolerated and the incidence of AEs was not significantly different from placebo. Similar rates of AEs were reported in all three treatment arms (67.3%, 71.4%, and 72.7% of patients in the 10-mg, 25-mg, and placebo groups, respectively). Rates of reported hypoglycemia (plasma glucose ≤70 mg/dL and/or requiring assistance) were also similar across treatment arms (1.2%, 2.4%, and 1.8% of the respective groups), and no patient required assistance. The proportion of patients with AEs related to UTIs was similar across groups (17.0%, 11.9%, and 16.4% of patients on 10 mg, 25 mg, and placebo, respectively); events consistent with genital infection were seen more commonly with empagliflozin (8.5%, 3.6%, and 2.4% of patients on 10 mg, 25 mg, and placebo, respectively); however, all were mild or moderate in intensity and none led to premature study discontinuation [
36]. Measurement of serum lipids showed significant increase in HDL-cholesterol in the empagliflozin 10-mg group, but a non-significant increase in the 25-mg group (Table
6). No significant differences were reported for total cholesterol, LDL-cholesterol, or triglycerides in either of the empagliflozin treatment arms (Table
6). Again, small decreases were seen in uric acid levels with empagliflozin, of approximately the same level seen in the study of empagliflozin as add-on to metformin plus sulfonylurea (Table
7).