Jardiance (Empagliflozin) for Pulmonary Hypertension
Based on current guidelines, Jardiance (empagliflozin) is not recommended as a specific treatment for pulmonary hypertension as there is insufficient clinical evidence supporting its use for this indication. 1
Classification and Treatment Approach to Pulmonary Hypertension
- Pulmonary hypertension (PH) is classified into five groups based on etiology, with different treatment approaches for each 1
- Current guidelines recommend treating the underlying condition causing PH before considering specific PH therapies 1
- For PH due to lung diseases (Group 3), optimization of the underlying lung disease and long-term oxygen therapy for hypoxemic patients are the mainstays of treatment 1
- For PH due to left heart disease (Group 2), aggressive treatment of the underlying heart failure or valvular disease is recommended 1, 2
Current Evidence on Empagliflozin and Pulmonary Hypertension
- There is limited research on empagliflozin specifically for pulmonary hypertension 3
- One preclinical study in rats showed that empagliflozin reduced mortality and prevented progression in experimental pulmonary hypertension 3
- In a study of heart failure with preserved ejection fraction (HFpEF) with exercise-induced pulmonary hypertension, empagliflozin improved metabolic syndrome and prevented exercise-induced PH in an animal model 4
- While empagliflozin is approved for heart failure regardless of ejection fraction, this approval does not specifically address its use for pulmonary hypertension 5
Established Treatments for Different Types of Pulmonary Hypertension
For PH due to lung diseases:
For PH due to left heart disease:
Clinical Implications and Cautions
- Despite promising preclinical data, there are no completed randomized controlled trials supporting the use of empagliflozin specifically for pulmonary hypertension 3, 4
- Using medications without established evidence in PH can potentially worsen outcomes, as has been seen with other drug classes 1
- Patients with suspected PH should be referred to specialized PH centers for proper diagnosis and treatment planning 1
- Definitive diagnosis of PH requires right heart catheterization, which is essential before initiating specific therapies 1
Conclusion
While empagliflozin shows promise in preclinical models for pulmonary hypertension 3, 4 and is approved for heart failure 6, 5, current guidelines do not support its use as a specific treatment for pulmonary hypertension 1. Treatment should focus on addressing the underlying cause of PH and following established treatment algorithms based on PH classification 1.