- EMPERIAL clinical trials will evaluate the effect of empagliflozin on exercise ability and heart failure symptoms in people with chronic heart failure1,2
- EMPERIAL is part of the most comprehensive clinical trial programme of an SGLT2 inhibitor in chronic heart failure3,4
Boehringer Ingelheim and Eli Lilly and Company announced plans to expand their clinical trial programme for empagliflozin in chronic heart failure with the EMPERIAL clinical trials. These trials will evaluate the effect of empagliflozin on exercise ability and heart failure symptoms in people with chronic heart failure independent of whether they have type 2 diabetes. EMPERIAL comprises two Phase III trials that will assess the effect of 12 weeks’ treatment with empagliflozin on the ability of people with heart failure to perform daily exercise.1,2
The plans for the EMPERIAL trials follow initiation of the EMPEROR trials in March 2017.3,4 While the EMPEROR outcome trials focus on long-term morbidity and mortality outcomes in people with heart failure, the EMPERIAL functional trials will investigate possible benefits on exercise capacity and heart failure symptoms.3,4 These studies are based on data obtained from the landmark EMPA-REG OUTCOME® trial, where the effect of empagliflozin on heart failure outcomes was evaluated.5
“Symptoms of heart failure can have a profound effect on quality of life, with more than three quarters of people with heart failure finding it difficult to carry out routine activities,” said Jeff Emmick, M.D., Ph.D., vice president, Product Development, Lilly Diabetes. “Currently, there are limited treatment options that can help improve the everyday lives of people living with chronic heart failure. We look forward to seeing whether empagliflozin can help address this unmet need.”
Heart failure is a serious condition where the heart is unable to pump enough blood around the body.6 It affects 26 million people worldwide and is associated with high morbidity and mortality.7 Approximately 50 percent of people who develop heart failure die within five years and it is the leading cause of hospitalisation in the United States and Europe.6,8
“In the EMPA-REG OUTCOME® trial, it was encouraging to see a significant reduction in the risk of hospitalisation for heart failure with empagliflozin in people with type 2 diabetes and established cardiovascular disease,” said Prof Dr Martina Brückmann, Global Head of Clinical Development, Therapeutic Area CardioMetabolism, Boehringer Ingelheim. “Boehringer Ingelheim and Lilly will conduct the EMPERIAL trials to investigate whether empagliflozin could also improve daily exercise and quality of life for people with chronic heart failure with or without type 2 diabetes.”
About EMPERIAL
EMPERIAL consists of two Phase III randomised, double-blind trials. The trials evaluate the effect of 12 weeks treatment of once daily empagliflozin 10 mg compared with placebo on exercise ability and heart failure symptoms in patients with chronic heart failure with preserved or reduced ejection fraction.* This will be measured by the 6-minute walk test, a common measure of functional exercise capacity.
EMPERIAL-preserved [NCT03448406]: will investigate empagliflozin in patients with chronic heart failure with preserved ejection fraction (HFpEF). The study looks at a functional endpoint: how far patients can walk in 6 minutes and at heart failure symptoms.1
- Primary endpoint: Change from baseline to week 12 in exercise capacity as measured by the distance walked in 6 minutes
- Anticipated number of patients: approx. 300
- Estimated completion: 2019
EMPERIAL-reduced [NCT03448419]: will investigate empagliflozin in patients with chronic heart failure with reduced ejection fraction (HFrEF). The study looks at a functional endpoint: how far patients can walk in 6 minutes and at heart failure symptoms.2
- Primary endpoint: Change from baseline to week 12 in exercise capacity as measured by the distance walked in 6 minutes
- Anticipated number of patients: approx. 300
- Estimated completion: 2019
*Ejection fraction is a measurement of the percentage of blood leaving the heart each time it contracts. During each heartbeat pumping cycle, the heart contracts and relaxes. When the heart contracts, it ejects blood from the two pumping chambers (ventricles). When the heart relaxes, the ventricles refill with blood.9
HFpEF occurs when the heart muscle contracts normally but the ventricle muscles are stiff. They do not relax as they should when the ventricle fills with blood, so less blood can enter the heart compared to a normally functioning heart.10
HFrEF occurs when the heart muscle does not contract effectively and less blood is pumped out to the body compared to a normally functioning heart.10
Both, HFpEF and HFrEF lead to similar symptoms of heart failure, specifically difficulty breathing, swelling, and fatigue.
About Heart Failure
Heart failure is a progressive, debilitating and potentially fatal condition that occurs when the heart cannot pump enough blood around the body.6 Symptoms of heart failure include difficulty breathing, swelling, and fatigue amongst others.11 Heart failure is a prevalent disease; 26 million people around the world have chronic heart failure.7 There is a high unmet need in the treatment of heart failure, as approximately 50 percent of people diagnosed with heart failure will die within five years.8 Additionally, heart failure represents the most common cause of hospitalisation among individuals aged 65 years and over in the United States and Europe.7 Heart failure is highly prevalent in people with diabetes;12 however, approximately half of all people with heart failure do not have diabetes.7,13
About Empagliflozin
Empagliflozin (marketed as Jardiance®) is an oral, once daily, highly selective sodium glucose cotransporter 2 (SGLT2) inhibitor and the first type 2 diabetes medicine to include cardiovascular death reduction data in the label in several countries.14,15,16
Inhibition of SGLT2 with empagliflozin in people with type 2 diabetes and high blood sugar levels leads to excretion of excess sugar in the urine. In addition, initiation of empagliflozin increases excretion of salt from the body (i.e. sodium) and reduces the fluid load of the body’s blood vessel system (i.e. intravascular volume). The glucosuria, natriuresis and osmotic diuresis observed with empagliflozin may contribute to the improvement in cardiovascular outcomes.
Empagliflozin is not for people with type 1 diabetes or for people with diabetic ketoacidosis (increased ketones in the blood or urine).
References
1 A phase III randomised, double-blind trial to evaluate the effect of 12 weeks treatment of once daily EMPagliflozin 10 mg compared with placebo on ExeRcise ability and heart failure symptoms, In patients with chronic HeArt FaiLure with preserved Ejection Fraction (HFpEF) (EMPERIAL – preserved). Available at: https://clinicaltrials.gov/ct2/show/NCT03448406?term=EMPERIAL&rank=1. Last accessed February 2018.
2 A phase III randomised, double-blind trial to evaluate the effect of 12 weeks treatment of once daily EMPagliflozin 10 mg compared with placebo on ExeRcise ability and heart failure symptoms, In patients with chronic HeArt FaiLure with reduced Ejection Fraction (HFrEF) (EMPERIAL – reduced). Available at: https://clinicaltrials.gov/ct2/show/NCT03448419?term=EMPERIAL&rank=2. Last accessed February 2018.
3 EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved). Available at: https://clinicaltrials.gov/ct2/show/NCT03057951?term=emperor&rank=2. Last accessed January 2018.
4 EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction (EMPEROR-Reduced). Available at: https://clinicaltrials.gov/ct2/show/NCT03057977?term=emperor&rank=1. Last accessed January 2018.
5 Zinman B, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015;373:2117–28.
6 American Heart Association. What is Heart Failure? Available at: http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/What-is-Heart-Failure_UCM_002044_Article.jsp#.WleEeLSFjBI. Last accessed February 2018.
7 Ambrosy A.P., et al. The Global Health and Economic Burden of Hospitalizations for Heart Failure. J Am Coll Cardiol 2014. 1;63(12):1123-1133.
8 Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, et al. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013;127:e6–e245
9 Ejection Fraction. Heart Rhythm Society. Available at: http://www.hrsonline.org/Patient-Resources/The-Normal-Heart/Ejection-Fraction. Last accessed February 2018.
10 American Heart Association. Ejection Fraction Heart Failure Measurement. Available at http://www.heart.org/HEARTORG/Conditions/HeartFailure/DiagnosingHeartFailure/Ejection-Fraction-Heart-Failure-Measurement_UCM_306339_Article.jsp#.WJ3BSm-LRxB. Last accessed January 2018.
11 Watson RDS, Gibbs CR, Lip GYH. Clinical features and complications. British Medical Journal. 2000;320(7229):236-239.
12 Yancy CW., et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 62 (16), e147 – e239.
13 Suskin N, et al. Glucose and insulin abnormalities relate to functional capacity in patients with congestive heart failure. Eur Heart J 2000;21:1368-75.
14 Jardiance® (empagliflozin) tablets U.S. Prescribing Information. Available at: http://docs.boehringer-ingelheim.com/Prescribing%20Information/PIs/Jardiance/jardiance.pdf. Last accessed January 2018.
15 European Summary of Product Characteristics Jardiance®, approved January 19, 2017. Data on file.
16 Jardiance® (Full Prescribing Information). Mexico; Boehringer Ingelheim Pharmaceuticals, Inc; 2017.