Empagliflozin can be used as add-on to standard care in CKD, NICE recommends

NICE has recommended that empagliflozin can be used as an option for treating chronic kidney disease (CKD) in adults under some circumstances.

It has to be prescribed as an add-on to standard care including the highest tolerated dose of ACE inhibitor or angiotensin-receptor blocker unless contraindicated, a Technology Appraisal has stated.

Under the recommendations patients must also have an estimated glomerular filtration rate of:

• 20 ml/min/1.73 m² to less than 45 ml/min/1.73 m² or
• 45 ml/min/1.73 m² to 90 ml/min/1.73 m² and either a urine albumin-to-creatinine ratio of 22.6 mg/mmol or more, or type 2 diabetes

Clinicians in both primary and secondary care should make prescribing decisions based on cost of suitable treatments including dapagliflozin after discussing the pros and cons with the patient, NICE said.

The committee noted that some patients already take dapagliflozin as an add-on to standard care and empagliflozin would be used in a similar way but with a potentially broader population.

Evidence from the EMPA-KIDNEY trial suggests that empagliflozin plus standard care is more effective than standard care alone but there were limits on who was included in the studies, NICE said.

There are also no trials directly comparing empagliflozin plus dapagliflozin but it is likely that effectiveness and safety is similar, the committee said.

It was acknowledged that CKD can progress more quickly in some ethnic minority groups in people under 55 with type 2 diabetes but this could not be considered in the decision making, the committee noted.

The SGLT2 inhibitor is already recommended by NICE for the treatment of adult patients with type 2 diabetes and adult patients with heart failure with reduced ejection fraction.

NICE’s decision to include empagliflozin as an option in some patients with CKD means it must be made available within three months.

Dapagliflozin was approved for CKD in 2022 with estimates at the time suggesting up to 91,000 patients could be eligible.

In papers published by the NICE committee, it notes that the use of SGLT2 inhibitors is not yet well established in clinical practice and there is ‘scope to expand the use of this drug class in this indication to slow CKD disease progression’.