HFpEF has been classified as “the single largest unmet need in cardiovascular medicine”[1] based on prevalence, poor outcomes and the absence of clinically proven therapies to date[2]
With approval, empagliflozin would become the first and only clinically proven therapy to improve outcomes for the full spectrum of heart failure patients regardless of ejection fraction

INGELHEIM, GERMANY & INDIANAPOLIS-- July 07, 2021 -- The EMPEROR-Preserved Phase III trial met its primary endpoint, establishing empagliflozin as the first and only therapy to significantly reduce the risk of the composite of cardiovascular death or hospitalization for heart failure in adults, with or without diabetes, who live with heart failure with preserved ejection fraction (HFpEF). Boehringer Ingelheim and Eli Lilly and Company (NYSE: LLY) announced the topline results today. When added to the EMPEROR-Reduced trial results, these findings demonstrate empagliflozin’s efficacy in all forms of heart failure regardless of ejection fraction. The safety profile was generally consistent with the known safety profile of empagliflozin.

“We look forward to presenting the EMPEROR-Preserved results at ESC 2021, which should offer a breakthrough in cardiovascular medicine and a new hope for people with HFpEF, which is an increasingly prevalent public health issue. HFpEF has long been the most challenging form of heart failure to treat,” said Professor Stefan Anker, Heart Failure Cardiologist at Charité Berlin, Germany, and EMPEROR-Preserved Principal Investigator. “Building on previous results from the EMPA-REG-OUTCOME trial, and the EMPEROR-Reduced trial in heart failure with reduced ejection fraction, the EMPEROR-Preserved findings demonstrate that empagliflozin reduces cardiovascular death or hospitalization for heart failure and has the potential to transform the care of people living with heart failure.”

Heart failure poses a significant global disease burden: more than 60 million patients worldwide have heart failure and half of them have HFpEF.[3,4] Heart failure is a leading cause of hospitalization and is becoming increasingly prevalent in Western countries due to aging populations.[3] The risk of death in people with heart failure rises with each hospital admission.[5] Heart failure with left ventricular preserved ejection fraction occurs when the left ventricle of the heart is unable to fill properly, resulting in less blood being pumped to the body.[6]

“The totality of evidence from the trial points to the potential of empagliflozin to redefine treatment of heart failure with preserved ejection fraction, which affects approximately 30 million people worldwide,” said Waheed Jamal, M.D., Corporate Vice President and Head of CardioMetabolic Medicine, Boehringer Ingelheim. “Until now, there have been no clinical studies demonstrating reduced risk of heart failure hospitalizations or cardiovascular mortality for all adults with this prevalent and life-limiting condition. With the earlier EMPEROR-Reduced trial results, we are confident in the potential of empagliflozin to positively impact the lives of adults across the full spectrum of heart failure.”

“Empagliflozin was the first SGLT2 inhibitor to reduce cardiovascular death for people with type 2 diabetes and cardiovascular disease, and we have now reached another important milestone, this time in heart failure,” added Jeff Emmick, M.D., Ph.D., Vice President, Product Development, Lilly. “The EMPEROR-Preserved topline results offer promise in a type of heart failure that until now has traditionally been very challenging to treat effectively. The EMPEROR heart failure studies are part of our EMPOWER clinical trial program exploring the effect of empagliflozin across a spectrum of cardio-renal-metabolic diseases, aiming to significantly improve outcomes in these highly prevalent conditions that impact many people’s lives.”

The EMPEROR-Preserved trial investigated empagliflozin 10 mg compared to placebo.[7] Full results from the EMPEROR-Preserved trial are scheduled for presentation at the European Society of Cardiology (ESC) Congress 2021 on 27 August. Boehringer Ingelheim and Lilly plan for regulatory submissions in 2021.

These results add to previous findings from the EMPEROR-Reduced Phase III trial, which showed that empagliflozin significantly reduced the combined relative risk of cardiovascular death or hospitalization for heart failure by 25 percent, compared to placebo in adults with heart failure with reduced ejection fraction (HFrEF).[8] Together, these studies demonstrate the benefits of empagliflozin for patients across the full heart failure spectrum (including HFrEF and HFpEF).

The EMPEROR-Reduced results formed the basis of the recent approval of a new indication for empagliflozin for the treatment of adults with HFrEF by the European Commission.[9] A supplemental New Drug Application (sNDA) for empagliflozin to reduce the risk of cardiovascular death or hospitalization for heart failure in adults with HFrEF has been submitted to the U.S. Food and Drug Administration (FDA), with a decision expected later this year.[10] Empagliflozin is currently indicated for the treatment of adults with insufficiently controlled type 2 diabetes (and additionally in the E.U., for the treatment of adults with HFrEF).[9,11-13] Research is ongoing regarding empagliflozin’s effects on hospitalization for heart failure and mortality in post-myocardial infarction (heart attack) patients with high risk of heart failure.[14] Empagliflozin is also currently being investigated in chronic kidney disease.[15]

About the EMPEROR heart failure studies[7,16]
The EMPEROR (EMPagliflozin outcomE tRial in patients with chrOnic heaRt failure) chronic heart failure studies were two Phase III, randomized, double-blind trials that investigated once-daily empagliflozin compared to placebo in adults with chronic HFrEF or HFpEF, with or without diabetes:

· EMPEROR-Reduced [NCT03057977] investigated the safety and efficacy of empagliflozin in patients with chronic HFrEF.

· Primary endpoint: time to first event of adjudicated cardiovascular death or adjudicated hospitalization for heart failure
· Number of patients: 3,730
· Completion: 2020

· EMPEROR-Preserved [NCT03057951] investigated the safety and efficacy of empagliflozin in patients with chronic HFpEF.

· Primary endpoint: time to first event of adjudicated cardiovascular death or adjudicated hospitalization for heart failure
· Number of patients: 5,988
· Completion: 2021

Ejection fraction is a measurement of the percentage of blood the left ventricle pumps out with each contraction.[17] When the heart relaxes, the ventricle refills with blood.