Empagliflozin has potential of lowering progression of Diabetic Retinopathy among diabetes patients: S6

Diabetic Retinopathy (DR) is a
prevalent complication in diabetics. It is the leading cause of irreversible
vision loss among type 2 diabetics. Empagliflozin has significant protective
effects against adverse cardiorenal outcomes in previous trials. They inhibit
the retinal sodium-glucose cotransporter 2 protein and prevent retinal pericyte
loss, thus decreasing the progression of DR. As there is limited data on the
association between the role of empagliflozin and DR, researchers
conducted a study to evaluate the association between empagliflozin use and the
risk of incident nonproliferative DR (NPDR) and DR progression within the
Empagliflozin Comparative Effectiveness and Safety (EMPRISE) study.

A new-user active-comparator
cohort study was carried out based on US nationwide insurance claims data
from 2 commercial insurers and Medicare from August 2014 to September 2019.
Individuals using empagliflozin between August 2014 and September 2019 were
included in the study, with DPP4i as the comparator. Adults with T2D initiating
study drugs without prior diagnosis or treatment for proliferative DR or other
advanced retinal diseases were included. To assess incident NPDR, patients with
a history of NPDR were additionally excluded, while for the DR progression
outcome, patients were required to have a history of NPDR. The occurrence of
nonproliferative DR (NPDR) and the progression of DR were considered the
primary outcomes of measurement. Incident NPDR was defined using diagnostic
codes for mild, moderate, or severe NPDR. The DR progression outcome was described
as a composite of incident proliferative DR, vitreous hemorrhage, intravitreal
anti-vascular endothelial growth factor injection initiation, or pan-retinal
photocoagulation.

Findings:

• About 34 239 propensity-score-matched adults
  were identified in the incident NPDR cohort and 7831 pairs in the DR
  progression cohort.
• In the incident NPDR cohort, 35 867 patients
  (52.4%) were male, and the mean (SD) age was 65.6 (10.3) years.
• In the DR progression cohort, 8229 patients
  (52.5%) were male, and the mean (SD) age was 67.0 (10.0) years.
• There was no difference in the risk of incident
  NPDR between the two groups over a mean (SD) follow-up period of 8 (7.5) months
  of receiving treatment.
• However, the empagliflozin group showed a lower
  risk of DR progression compared with those who began DPP4i therapy.
• Multiple subgroups and sensitivity analyses also
  showed consistent results.

Thus, the study concluded that empagliflozin
is beneficial as it showed a reduced risk of DR progression compared to DPP4i
initiation. Even though empagliflozin and DPP4i were similar in reducing the
risk of incident NPDR, empagliflozin’s potential to lower the progression of
diabetic retinopathy may influence the choice of the drug for glucose-lowering
treatments in diabetic individuals.

Further reading: Tesfaye H, Paik
JM, Roh M, et al. Empagliflozin and the Risk of Retinopathy in Patients
With Type 2 Diabetes. JAMA Ophthalmol. Published online
December 05, 2024. doi:10.1001/jamaophthalmol.2024.5219.