NICE guidance - empagliflozin for treating chronic kidney disease

NICE states:

Empagliflozin is recommended as an option for treating chronic kidney disease (CKD) in adults, only if:

• it is an add-on to optimised standard care, including the highest tolerated licensed dose of angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), unless these are contraindicated, and
• people 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

The NICE committee noted:

• clinical trial evidence suggests that empagliflozin plus standard care is more effective than standard care alone
• there are no clinical trials directly comparing empagliflozin with dapagliflozin in people with CKD
  • results of an indirect comparison suggest that empagliflozin has a similar effectiveness to dapagliflozin, and it likely has similar safety
• CKD can progress more quickly in some ethnic minority groups, and, in people with type 2 diabetes, it progresses more quickly in people under 55
  • was acknowledged but could not be considered in the decision-making

Reference:

• NICE (December 2023). Empagliflozin for treating chronic kidney disease.