Dr Milton Packer Shares "Extraordinary" Results From the EMPEROR Trial

The latest findings from the EMPEROR trial were presented at the European Society of Cardiology (ESC) Congress 2023 and focused the effects of empagliflozin discontinuation. According to Milton Packer, MD, of Baylor University Medical Center in Dallas, Texas, these findings demonstrate that the benefit of sodium glucose co-transporter 2 (SGLT2) inhibitors disappears within 30 days after patients stop taking the drug.

Transcript

What are the latest updates on the EMPEROR trial being presented at ESC Congress 2023?

The most exciting results we presented at this meeting on the EMPEROR trial was the withdrawal of empagliflozin in 7000 patients—7000 patients who had survived to the end of the trial, half on placebo half on empagliflozin, and they were blindly withdrawn for 30 days. No one had ever done this before. No one had ever done this with any foundational drug before. We give foundational drugs forever, for years, and we don't know whether they keep working or not. The only way to know if they work or not is to take them away and see if patients can continue to be stable or get worse.

When we withdrew people from placebo, they remained completely stable, as you would expect—we were taking away placebo. When we took away empagliflozin, there was a 70% increase in heart failure events, there was worsening of symptoms, worsening of health status, and all of the renal tubular effects of SGLT2 inhibitors reversed. All the biochemical changes, laboratory changes, [and] physical signs all reversed, and they were the mirror image of what we saw at the very beginning of the trial.

So, the conclusions that we reached is empagliflozin persists for years. It produces its benefits, which continue for as long as the patient takes the drug. But, if the patient stops taking the drug, they're going to get worse within 30 days. We thought that was extraordinary.