Aim
To assess the efficacy and safety of the novel sodium‐glucose cotransporter 2 (SGLT2) inhibitor empagliflozin compared with placebo or other antidiabetic agents in patients with type 2 diabetes.
Methods
We conducted a systematic review and meta‐analysis of randomized controlled trials. We searched Medline, Embase and the Cochrane Library through December 2013 and grey literature. Two reviewers working independently extracted relevant data and carried out risk‐of‐bias assessments. We synthesized results using random‐effects models and computed weighted mean differences (WMDs) and odds ratios (ORs).
Results
We included 10 studies with 6203 participants. Compared with placebo, mean changes in haemoglobin A1c were −0.62% [95% confidence interval (CI) −0.68 to −0.57%] for empagliflozin 10 mg and −0.66% (−0.76 to −0.57%) for empagliflozin 25 mg. Empagliflozin 25 mg daily had glycaemic efficacy similar to metformin or sitagliptin (WMD −0.11%; 95% CI −0.25 to 0.03%), without increasing risk for hypoglycaemia. It was also associated with body weight loss (WMD −1.84; 95% CI −2.30 to −1.38 kg vs. placebo) and had a favourable effect on blood pressure. Incidence of hypoglycaemia with empagliflozin was similar to placebo (OR 1.10; 95% CI 0.87 to 1.39); nevertheless we noted an increased risk for genital tract infections (OR 3.31; 95% CI 1.55 to 7.09). Findings were similar for the 10‐mg dosing regimen.
Conclusions
Empagliflozin effectively lowers blood glucose and provides additional clinical benefits including body weight and blood pressure reduction. Ongoing trials will elucidate the long‐term safety and effect of empagliflozin on cardiovascular outcomes.