Empagliflozin benefits similar between MRA users, nonusers

In patients with heart failure (HF) and preserved ejection fraction, treatment with empagliflozin delivers comparable benefits in reducing first hospitalization for HF or cardiovascular death (primary outcome) between users and nonusers of mineralocorticoid receptor antagonists (MRA), reports a study.

Moreover, MRA nonusers appear to benefit more from the effect of empagliflozin to reduce first and recurrent HF hospitalizations. The study drug also reduced hyperkalaemia, with no significant treatment-by-MRA subgroup interaction.

The investigators carried out survival analyses to compare the effects of empagliflozin vs placebo in MRA users and nonusers at baseline with treatment-by-MRA use interaction terms. The analysis included 5,988 patients, of whom 2,244 (37.5 percent) were using MRAs at baseline.

Event rates were higher among MRA users than nonusers (placebo group primary outcome, 9.4 vs 8.2 events per 100 person-years).

The benefit of empagliflozin to reduce the primary outcome did not significantly differ between MRA users (hazard ratio [HR], 0.87, 95 percent confidence interval [CI], 0.71‒1.06) and nonusers (HR, 0.73, 95 percent CI, 0.62‒0.87; p=0.22 for interaction).

Of note, the effect of empagliflozin in reducing first and recurrent HF hospitalizations was more robust among MRA nonusers than users (nonusers: HR, 0.60, 95 percent CI, 0.47‒0.77; users: HR, 0.90, 95 percent CI, 0.68‒1.19; p=0.038 for interaction).

Hyperkalaemic events were nearly twice as frequent among MRA users than nonusers. Empagliflozin reduced the risk for hyperkalaemia or initiation of potassium binders regardless of MRA use (MRA nonusers: HR, 0.90, 95 percent CI, 0.69‒1.19; MRA users: HR, 0.74, 95 percent CI, 0.56‒0.96; p=0.29 for interaction).

“MRAs may be beneficial in reducing HF hospitalizations in patients with HF with preserved ejection fraction,” the investigators said.