Type 2 Diabetes Therapies Trulicity and Jardiance Show Heart-Protective Effects

By Jeemin Kwon and Jimmy McDermott

Recently announced results from the REWIND and EMPRISE studies show heart protective effects of GLP1-agonist Trulicity and SGLT-2 inhibitor Jardiance in people with and without established heart disease

For people with type 2 diabetes, new study results from REWIND and EMPRISE offer compelling evidence that existing diabetes drugs may help the heart in those with and without existing heart disease.

REWIND trial finds Trulicity reduces risk of heart attack, stroke, and heart-related death:

REWIND study results show that Trulicity, a once-weekly injectable GLP-1 agonist therapy for people with type 2 diabetes, reduces heart attacks, strokes, and heart-related death compared to placebo (a “nothing” injection). The REWIND study followed nearly 10,000 people for more than five years; about a third of participants had established heart disease at the beginning of the study. Notably, the study also enrolled a high proportion of women.

EMPRISE trial studies Jardiance’s heart-protective benefits in real-world conditions:

In addition, initial results from the EMPRISE study showed that Jardiance, an SGLT-2 inhibitor approved for people with type 2 diabetes, reduced risk of hospitalization for heart failure by over 40% compared to DPP-4 inhibitors (Januvia, Tradjenta, etc.) in individuals with type 2 receiving routine clinical (“real world”) care. The findings from this real-world study complement the EMPA-REG trial results, which ultimately prompted the FDA to approve Jardiance as the first diabetes drug to reduce the risk for events like heart-related death for people with type 2 and existing heart disease.

What do these trials mean for people with type 2 diabetes?

While similar to other heart outcomes studies, both REWIND and EMPRISE stand out because they included people with type 2 diabetes without established heart disease (meaning, no previous heart attack or stroke or a condition called heart failure), whereas previous trials have only studied groups with existing heart problems. These positive findings in such a broad range of people are extremely compelling. We are eager to learn of the full results of REWIND at the 2019 ADA Scientific Sessions and results of EMPRISE at the 2018 American Heart Association (AHA) Scientific Sessions, happening this weekend.

Both study results contribute to a larger body of evidence suggesting that SGLT-2 inhibitors and GLP-1 agonists have heart-protective benefits for people with type 2 diabetes. So far, the drugs recognized by the US FDA and European EMA for their heart protective benefits in people with type 2 and existing heart disease are:

• Jardiance (SGLT-2 inhibitor): approved to reduce heart-related deaths

• Victoza (GLP-1 agonist): approved to reduce risk of heart attack, stroke, and heart-related death

Additionally, positive heart outcome trial results were recently announced for Farxiga, which also studied a population predominantly without heart disease. Regulatory bodies have not yet decided whether to update Farxiga’s label to include this information.

Because people with diabetes are at a greater risk for heart disease, it is exciting that existing diabetes therapies have heart-protective benefits. As healthcare providers are increasingly urged by the ADA and EASD to consider heart disease in choosing among various treatments, having more options will be helpful to people with diabetes.