Efficacy and safety of empagliflozin in type 2 diabetes mellitus: a meta-analysis of randomized controlled trials

Objectives: The prevalence of diabetes has increased in the recent decades and optimum glycemic control is required to reduce morbidity and mortality. We meta-analyzed randomized controlled trials in order to assess the efficacy and safety of empagliflozin compared to placebo in type 2 diabetes mellitus patients. Methods: We included double-blind, placebo controlled trials of empagliflozin that evaluated glycemic efficacy and safety (10mg or 25mg) either as monotherapy or as add-on to existing diabetes pharmacotherapy. Results: The results demonstrated significant improvements in HbA1c (SMD -0.929%, 95 % CI -1.064 to -0.793, for 10mg and -1.064%, 95 % CI -1.184 to -0.944, for 25mg) and FPG (SMD -0.929%, 95 % CI -1.064 to -0.793, for 10mg and -1.064%, 95 % CI -1.184 to -0.944, for 25mg) with empagliflozin monotherapy (n=609) compared to placebo. Significant improvements in HbA1c [SMD -1.582%, 95% CI -2.164 to -1.000, for 10mg (n=1079) and -1.668%, 95% CI -2.260 to -1.077, for 25mg (n=1070)] and FPG [SMD -0.865mmol/L, 95 % CI -1.309 to -0.420, for 10mg (n=854) and -0.996mmol/L, 95% CI -1.456 to -0.536, for 25mg (n=854)] were also observed in empagliflozin add-on therapy trials. Reductions in blood pressure and body weight were also seen in both monotherapy and add-on therapy. Empagliflozin was associated with increased risk of hypoglycemia, genital and urinary tract infections (OR 1.043, 2.814, 1.119 respectively). Conclusion: This meta-analysis shows empagliflozin is safe and effective for the treatment of T2DM along with existing diabetes pharmacotherapy.