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Empagliflozin (Jardiance°) in chronic heart failure

  Marketing Authorisations  Given the absence of any comparison with other heart-failure drugs, empagliflozin has not been shown to represent a therapeutic advance. In particular, when the left ventricular ejection fraction is reduced, there is no evidence to suggest that empagliflozin offers any advantages over dapagliflozin.
Full article (2 pages) available for download by subscribers

The drugs used to treat heart failure with preserved ejection fraction are generally the same as those employed in heart failure with reduced ejection fraction. However, as of late 2022, no drugs have been shown to extend survival in these patients in randomised clinical trials.

Empagliflozin, another gliflozin, has been authorised in the European Union for adults with symptomatic chronic heart failure, irrespective of the ventricular ejection fraction.

In these situations, when compared to the drugs already available, what advantages does empagliflozin offer in reducing mortality or preventing clinical complications such as acute decompensation? Does it represent an advance compared to dapagliflozin for patients with reduced ventricular ejection fraction? And what are its adverse effects?

As of late 2022, the clinical evaluation of empagliflozin in heart failure does not include any trials versus dapagliflozin, nor versus other heart-failure drugs such as the combination of sacubitril + valsartan. It is based on two double-blind, randomised, placebo-controlled trials in patients with symptomatic chronic heart failure despite appropriate treatment…

©Prescrire 1 March 2023

Source: "Empagliflozin (Jardiance°) in chronic heart failure. A second gliflozin in cardiology, without any demonstrated advantages" Prescrire International 2023; 32 (246): 62-63. Subscribers only.

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