Lower HbA1c Reached With Combined Empagliflozin/Linagliptin vs Monotherapy

This article is part of Endocrinology Advisor‘s coverage of the 26th American Association of Clinical Endocrinologists (AACE) Annual Scientific Sessions & Clinical Congress, taking place in Austin, Texas. Our staff will report on medical research and technological advances in diabetes, obesity, and thyroid conditions, conducted by experts in the field. Check back regularly for more news from AACE 2017.

A recent investigation found that patients with type 2 diabetes achieved tighter glucose control with empagliflozin/linagliptin single-pill combination therapy compared with monotherapy with either drug. Researchers from Boehringer Ingelheim discussed the findings at the 26th American Association of Clinical Endocrinologists (AACE) Annual Scientific Sessions & Clinical Congress, May 3-7, in Austin, Texas.

Pooling data from 2 phase 3 randomized trials (ClinicalTrials.gov identifier: NCT01422876 for both), the investigators examined outcomes and characteristics of patients who achieved glycated hemoglobin (HbA1c) ≤7% at week 12 and maintained that level at week 52. Of the combined sample, 677 patients were treatment-naive at baseline, and 686 were receiving background metformin therapy. Patients were assigned to 1 of the following therapies: empagliflozin/linagliptin 25 mg/5 mg or 10 mg/5 mg, empagliflozin 25 mg or 10 mg, or linagliptin 5 mg.

Significant differences were observed between groups based on treatment regimen. The percentage of patients achieving target HbA1c ≤7% at weeks 12 and 52 was 43.3% with empagliflozin/linagliptin 25 mg/5 mg, 45.9% with empagliflozin/linagliptin 10 mg/5 mg, 31.1% with empagliflozin 25 mg, 30.5 with empagliflozin 10 mg, and 21.8% with linagliptin 5 mg. The percentage of patients who achieved target HbA1c at week 12 but were above target at week 52 was 22.4% (empagliflozin/linagliptin 25 mg/5 mg), 17.8% (empagliflozin/linagliptin 10 mg/5 mg), 11.4% (empagliflozin 25 mg), 11.5% (empagliflozin 10 mg), and 15.3% (linagliptin 5 mg).

Further analysis revealed that baseline HbA1c and fasting plasma glucose (FPG) were the strongest predictors of HbA1c target attainment and maintenance. Mean baseline values among patients who demonstrated glucose control at 12 and 52 weeks were HbA1c 7.4% to 7.6% and FPG 137.9 to 145.7 mg/dL. Among those with target HbA1c at 12 weeks but not 52 weeks, mean baseline values were HbA1c 7.5% to 7.8% and FPG 136.7 mg/dL to 149.6 mg/dL. For patients with above-target HbA1c at 12 weeks, mean baseline values were HbA1c 8.3% to 8.5% and FPG 167.4 mg/dL to 177.1 mg/dL.

Taken together, these findings show that achievement and maintenance of target HbA1c in patients with type 2 diabetes was more prevalent among those treated with the empagliflozin/linagliptin single-pill combination therapy vs monotherapy with either drug. 

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Reference

Del Parigi A, Tang W, Meyer C, Liu D, Lee C, Pratley R. Achieving and maintaining HbA1c targets with empagliflozin/linagliptin single-pill combination therapy in type 2 diabetes. Abstract 280. Presented at: 26th American Association of Clinical Endocrinologists Annual Scientific Sessions & Clinical Congress. May 3-7, 2017; Austin, TX.