Empagliflozin and Combination Therapy

Members of the SGLT2 inhibitor family of medications are fairly new therapeutics that are approved world-wide for glycemic management of patients with type 2 diabetes (T2DM). In addition to their glycaemia-lowering actions, they also have remarkable effects in preventing recurrent CVD events in people with established CVD and some of the members have shown positive effects on renal outcomes. A continuing challenge in the management of patients with T2DM is the large number of medications that are needed on a daily basis to control the various aspects of this metabolic disorder and the difficulty faced by patients to adhere to the treatment plan. It has been known for years that combining 2 or 3 medications into one pill (poly-pill idea) improves adherence, efficacy, and outcomes in a variety of disorders. In this lecture, data on the mode of action of SGLT2 inhibitors will be presented, and the efficacy and safety of empagliflozin will be reviewed. Then, results of studies using combination therapy (in a fixed dose single tablet form) of empagliflozin plus metformin and empagliflozin plus linagliptin in drug naïve patients with T2DM will be summarized. Finally, results of a study on use of empagliflozin plus linagliptin in patients poorly controlled on metformin alone will be presented. The evidence shows that the combination therapy presents advantages for improved outcomes.