What is the use of Jardiance (Empagliflozin)?

From the Guidelines

Jardiance (empagliflozin) is a highly recommended medication for patients with type 2 diabetes, particularly those with established cardiovascular disease or at high risk of major adverse cardiovascular events, due to its proven benefits in reducing the risk of cardiovascular death, heart failure, and kidney disease, as demonstrated in recent high-quality studies such as the EMPA-REG OUTCOME trial 1 and the EMPEROR-Reduced trial 1.

Key Benefits of Jardiance

• Reduces the risk of cardiovascular death by 38% and heart failure hospitalizations by 35%, as shown in the EMPA-REG OUTCOME trial 1 and the EMPEROR-Reduced trial 1
• Provides renal protection by reducing the risk of kidney disease progression and end-stage kidney disease, as demonstrated in the CANVAS trial 1 and the DAPA-CKD trial 1
• Lowers blood sugar levels by blocking sodium-glucose cotransporter-2 (SGLT2) in the kidneys, causing excess glucose to be eliminated through urine rather than reabsorbed into the bloodstream

Important Considerations

• The standard starting dose of Jardiance is 10 mg once daily, taken in the morning with or without food, which may be increased to 25 mg daily if needed for better glucose control
• Common side effects include urinary tract infections, genital yeast infections, and increased urination, and patients should maintain adequate hydration while taking Jardiance and monitor for signs of diabetic ketoacidosis, a rare but serious side effect
• Those with type 1 diabetes, severe kidney disease, or dialysis dependency should not use this medication, and regular monitoring of kidney function and blood glucose levels is essential while on Jardiance therapy

Recent Evidence

• The EMPEROR-Reduced trial 1 demonstrated a 21% reduction in the primary composite outcome of cardiovascular death or hospitalization for worsening heart failure in patients with heart failure and an ejection fraction of 40% or less
• The DELIVER trial 1 showed an 18% reduction in the primary outcome of a composite of worsening heart failure, defined as hospitalization or urgent visit for heart failure, or cardiovascular death in patients with heart failure and an ejection fraction >40%

From the FDA Drug Label

1 INDICATIONS AND USAGE JARDIANCE is indicated: as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus, to reduce the risk of cardiovascular death in adult patients with type 2 diabetes mellitus and established cardiovascular disease.

Limitations of Use JARDIANCE is not recommended for patients with type 1 diabetes or for the treatment of diabetic ketoacidosis.

• Indications for Jardiance:
  • Improve glycemic control in adults with type 2 diabetes mellitus
  • Reduce the risk of cardiovascular death in adult patients with type 2 diabetes mellitus and established cardiovascular disease
• Limitations of Use: Not recommended for patients with type 1 diabetes or for the treatment of diabetic ketoacidosis 2

From the Research

Overview of Jardiance

• Jardiance, also known as empagliflozin, is a sodium glucose cotransporter-2 (SGLT2) inhibitor used in the treatment of type 2 diabetes 3, 4, 5, 6, 7.
• It is an effective and generally well-tolerated antihyperglycaemic agent, approved for use in adults with type 2 diabetes in several countries 3.

Mechanism of Action and Benefits

• Empagliflozin works by inhibiting the reabsorption of glucose from the proximal tubules in the kidney, providing a novel insulin-independent mechanism of lowering blood glucose 3, 6.
• It offers several benefits, including:
  • Improved glycaemic control 3, 4, 5, 6, 7
  • Reductions in body weight and blood pressure 3, 4, 6, 7
  • Cardioprotective and renoprotective properties, particularly in patients with established cardiovascular disease 3, 4, 5

Safety and Tolerability

• Empagliflozin is generally well-tolerated, with most adverse events being mild or moderate in intensity 3, 4, 6.
• Common adverse effects include genital infections, kidney failure, and diabetic ketoacidosis 4.
• There is also a potential risk of cancer, particularly bladder cancer, although this is still being investigated 4.

Clinical Trials and Studies

• Several clinical trials have demonstrated the efficacy and safety of empagliflozin in patients with type 2 diabetes, including the EMPA-REG OUTCOME trial 3, 4, 5.
• A systematic review and economic evaluation of empagliflozin and other SGLT2 inhibitors found that they are effective in improving glycaemic control, but may not be cost-effective compared to other treatments 7.