title: Following the results of the EMPA-REG OUTCOME trial with empagliflozin, is it possible to speak of a class effect?
abstract: BACKGROUND
  The recently published cardiovascular outcomes data for the first sodium-glucose cotransporter 2 (SGLT2) inhibitor, empagliflozin, have shown cardiovascular safety and additional benefits in patients with type 2 diabetes and established cardiovascular disease. Empagliflozin showed lower rates of death from cardiovascular causes or from any causes and lower hospitalization rates from heart failure compared with placebo, both in addition to standard care. This commentary discusses the existence of a possible class effect considering the available evidence described for other SGLT2 inhibitors.
  
  
  METHODS
  Empagliflozin, dapagliflozin and canagliflozin share the same mechanism of action, and it is a plausible hypothesis that some of the benefits of empagliflozin treatment could also be expected from other SGLT2 inhibitors. However, the rapid and persistent occurrence of cardiovascular benefits observed with empagliflozin and the different results shown by the three inhibitors in meta-analyses of some of their respective Phase II and III trials might suggest another possible mechanism of action, perhaps related to the different selectivity to inhibit SGLT-2 and other SGLT family members that these compounds present.
  
  
  CONCLUSIONS
  There is still lack of evidence to answer whether the cardiovascular benefits observed with empagliflozin in the EMPA-REG OUTCOME study could be seen as a "class effect", which is also attributable to dapagliflozin and canagliflozin.
authors.affiliation: Endocrinology and Nutrition Department, Clinic University Hospital Valencia, Valencia, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Ampudia-Blasco
authors.affiliation: Eli Lilly and Company España, Madrid, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Romera
authors.affiliation: Boehringer Ingelheim España, Barcelona, Spain.
authors.forename: Bernat
authors.initials: B
authors.lastname: Ariño
authors.affiliation: Endocrinology Department, Hospital Clinic Barcelona, Barcelona, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Gomis
keywords: SGLT2 inhibitors; canagliflozin; cardiovascular; dapagliflozin; empagliflozin; outcome studies