An observational study in Diabetes Mellitus, Type 2, sponsored by Boehringer Ingelheim. Completed at 1 site in Germany. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2024-02-08.
Sponsored by Boehringer Ingelheim · Observational
The primary objective of this exploratory meta-analysis is to evaluate the frequencies, incidence rates, and hazard ratios of lower-limb amputation (LLA) events (primary outcome) and of adverse events related to amputation (secondary outcome) in patients treated with empagliflozin compared with placebo in the pooled population of the long-term studies 1245.25, 1245.110, and 1245.121 (SAF-M1), in the pooled population of studies 1245.110 and 1245.121 (SAFM2), and in each of the 3 studies separately.
9,359 studies on the registry are indexed under Diabetes Mellitus, Type 2; 1,318 are open to participants now.
This study's enrollment of 16,746 is above the median of 300 across 1,588 observational studies indexed under Diabetes Mellitus, Type 2.
Browse Diabetes Mellitus, Type 2 studies →Boehringer Ingelheim is the lead sponsor of 2,245 studies on the registry; 58 are open to participants now.
Of its 162 completed or terminated interventional studies of FDA-regulated products, 116 (72%) have results posted.
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Patients with type 2 diabetes mellitus and increased cardiovascular risk (1245.25), patients with chronic heart failure with preserved ejection fraction (1245.110), and patients with chronic heart failure with reduced ejection fraction (1245.121), who were either treated with empagliflozin or placebo.
Inclusion Criteria for 1245.25:
Glycated haemoglobin (HbA1c) criteria
With high cardiovascular risk, defined as ≥1 of the following criteria
Inclusion criteria for 1245.110 and 1245.121
Ejection fraction (EF) and N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) criteria
Exclusion criteria for 1245.25
Exclusion criteria for 1245.110 and 1245.121
Participants of the EMP-REG OUTCOME study (1245.25) who received placebo.
Drug: Placebo
Participants of the EMPA-REG OUTCOME study (1245.25) who received a low dose of empagliflozin once daily (QD).
Drug: Empagliflozin
Participants of the EMP-REG OUTCOME study (1245.25) who received a high dose of empagliflozin once daily (QD).
Drug: Empagliflozin
Participants of the EMPEROR-Preserved study (1245.110) who received empagliflozin once daily (QD).
Drug: Empagliflozin
Participants of the EMPEROR-Preserved study (1245.110) who received placebo once daily (QD).
Drug: Placebo
Participants of the EMPEROR-Reduced study (1245.121) who received empagliflozin once daily (QD).
Drug: Empagliflozin
Participants of the EMPEROR-Reduced study (1245.121) who received placebo once daily (QD).
Drug: Placebo
Placebo
Empagliflozin once daily
Incidence Rate of Lower Limb Amputation (LLA)
Incidence rate of lower limb amputation (LLA). Incidence rate were provided as rate per 100 patients-years (pt-yrs) calculated as the observed number of patients with event divided by observed time-at-risk over all patients. Time at risk was derived as followed: Patient with event: time at risk in days = date of start of first event - treatment start date + 1. Patients without event: time at risk in days = last date on treatment + 7 days - treatment start date + 1. Abbreviation: pt-yrs = patient-years.
Time frame: From first to last dose of study medication plus 7 days to account for the residual drug effect, up to 1639 days.
Incidence Rate of Adverse Events Related to Amputation
Incidence rate of adverse events (AEs) related to amputation. Incidence rate were provided as rate per 100 patients-years (pt-yrs) calculated as the observed number of patients with event divided by observed time-at-risk over all patients. Time at risk was derived as followed: Patient with event: time at risk in days = date of start of first event - treatment start date + 1. Patients without event: time at risk in days = last date on treatment + 7 days - treatment start date + 1. A search with a pre-defined list of MedDRA preferred terms was performed to identify all AEs related to amputation. These AE included vascular disorders, diabetic-foot-related events, wound/infections, nervous system disorders and volume depletion events. Abbreviation: pt-yrs = patient-years.
Time frame: From first to last dose of study medication plus 7 days to account for the residual drug effect, up to 1639 days.
This meta-analysis includes three randomised, placebo-controlled, double-blind, parallel-group and event-driven studies (NCT01131676, NCT03057951, NCT03057977) to evaluate the risk of lower-limb amputation (LLA) in patients treated with empagliflozin compared to placebo in the pooled population (SAF-M1 vs. SAF-M2).
| Milestone | Trial NCT01131676: Placebo | Trial NCT01131676: Empagliflozin 10 mg | Trial NCT01131676: Empagliflozin 25 mg | Trial NCT03057951: Placebo | Trial NCT03057951: Empagliflozin 10 mg | Trial NCT03057977: Placebo | Trial NCT03057977: Empagliflozin 10 mg |
|---|---|---|---|---|---|---|---|
| Started | 2337 | 2347 | 2344 | 2991 | 2997 | 1867 | 1863 |
| Treated | 2333 | 2345 | 2342 | 2989 | 2996 | 1863 | 1863 |
| Completed | 1650 | 1790 | 1800 | 2046 | 2051 | 1352 | 1381 |
| Not completed | 687 | 557 | 544 | 945 | 946 | 515 | 482 |
| Withdrew: Study drug stopped, reason missing | 5 | 3 | 4 | 6 | 1 | 0 | 0 |
| Withdrew: Other than stated below | 173 | 143 | 125 | 44 | 45 | 28 | 31 |
| Withdrew: Patient refusal to continue, not due to ae | 172 | 118 | 122 | 304 | 284 | 124 | 92 |
| Withdrew: Lost to follow-up | 15 | 9 | 6 | 6 | 16 | 11 | 17 |
| Withdrew: Protocol violation | 15 | 15 | 12 | 30 | 24 | 5 | 5 |
| Withdrew: Adverse event | 303 | 267 | 273 | 553 | 575 | 343 | 337 |
| Withdrew: Not treated | 4 | 2 | 2 | 2 | 1 | 4 | 0 |
Incidence rate of adverse events (AEs) related to amputation. Incidence rate were provided as rate per 100 patients-years (pt-yrs) calculated as the observed number of patients with event divided by observed time-at-risk over all patients. Time at risk was derived as followed: Patient with event: time at risk in days = date of start of first event - treatment start date + 1. Patients without event: time at risk in days = last date on treatment + 7 days - treatment start date + 1. A search with a pre-defined list of MedDRA preferred terms was performed to identify all AEs related to amputation. These AE included vascular disorders, diabetic-foot-related events, wound/infections, nervous system disorders and volume depletion events. Abbreviation: pt-yrs = patient-years.
| Patients with events per 100 pt-yrs | SAF-M1 Placebo | SAF-M1 Empagliflozin | SAF-M2 Placebo | SAF-M2 Empagliflozin 10 mg | Trial NCT01131676: Placebo | Trial NCT01131676: Empagliflozin 10 mg or 25 mg | Trial NCT03057951: Placebo | Trial NCT03057951: Empagliflozin 10 mg | Trial NCT03057977: Placebo | Trial NCT03057977: Empagliflozin 10 mg |
|---|---|---|---|---|---|---|---|---|---|---|
| Vascular adverse event | 1.48 (1.28 to 1.69) | 1.57 (1.40 to 1.75) | 1.27 (1.03 to 1.54) | 1.21 (0.98 to 1.47) | 1.77 (1.44 to 2.13) | 1.81 (1.57 to 2.06) | 1.21 (0.94 to 1.51) | 1.17 (0.90 to 1.47) | 1.44 (0.98 to 1.97) | 1.33 (0.90 to 1.85) |
| Diabetic foot related AE | 0.50 (0.39 to 0.63) | 0.64 (0.53 to 0.76) | 0.32 (0.21 to 0.46) | 0.46 (0.32 to 0.62) | 0.75 (0.54 to 0.99) | 0.76 (0.62 to 0.93) | 0.38 (0.23 to 0.55) | 0.30 (0.18 to 0.46) | 0.18 (0.05 to 0.39) | 0.84 (0.51 to 1.26) |
| Infections potentially related to LLA | 2.19 (1.94 to 2.44) | 2.04 (1.85 to 2.25) | 1.85 (1.56 to 2.17) | 1.78 (1.50 to 2.09) | 2.64 (2.23 to 3.09) | 2.22 (1.96 to 2.50) | 1.97 (1.62 to 2.36) | 1.75 (1.42 to 2.11) | 1.57 (1.09 to 2.13) | 1.88 (1.35 to 2.49) |
| Wound/infection | 0.86 (0.71 to 1.02) | 0.86 (0.73 to 0.99) | 0.65 (0.49 to 0.84) | 0.46 (0.32 to 0.62) | 1.14 (0.87 to 1.43) | 1.12 (0.94 to 1.32) | 0.61 (0.42 to 0.83) | 0.48 (0.32 to 0.68) | 0.76 (0.44 to 1.16) | 0.40 (0.18 to 0.70) |
| Nervous system disorder | 1.54 (1.34 to 1.76) | 1.81 (1.62 to 2.00) | 0.85 (0.66 to 1.07) | 0.92 (0.72 to 1.14) | 2.53 (2.12 to 2.96) | 2.41 (2.14 to 2.70) | 0.92 (0.69 to 1.19) | 0.99 (0.74 to 1.27) | 0.67 (0.37 to 1.05) | 0.75 (0.44 to 1.15) |
| Volume depletion | 0.67 (0.54 to 0.81) | 0.65 (0.54 to 0.77) | 0.95 (0.75 to 1.18) | 1.16 (0.94 to 1.41) | 0.28 (0.16 to 0.43) | 0.32 (0.23 to 0.43) | 0.90 (0.67 to 1.17) | 1.16 (0.90 to 1.46) | 1.08 (0.69 to 1.55) | 1.16 (0.76 to 1.64) |
Incidence rate of lower limb amputation (LLA). Incidence rate were provided as rate per 100 patients-years (pt-yrs) calculated as the observed number of patients with event divided by observed time-at-risk over all patients. Time at risk was derived as followed: Patient with event: time at risk in days = date of start of first event - treatment start date + 1. Patients without event: time at risk in days = last date on treatment + 7 days - treatment start date + 1. Abbreviation: pt-yrs = patient-years.
| Patients with events per 100pt-yrs | SAF-M1 Placebo | SAF-M1 Empagliflozin | SAF-M2 Placebo | SAF-M2 Empagliflozin 10 mg | Trial NCT01131676: Placebo | Trial NCT01131676: Empagliflozin 10 mg or 25 mg | Trial NCT03057951: Placebo | Trial NCT03057951: Empagliflozin 10 mg | Trial NCT03057977: Placebo | Trial NCT03057977: Empagliflozin 10 mg |
|---|---|---|---|---|---|---|---|---|---|---|
| Incidence Rate of Lower Limb Amputation (LLA) | 0.40 (0.30 to 0.52) | 0.48 (0.39 to 0.58) | 0.27 (0.17 to 0.39) | 0.23 (0.13 to 0.34) | 0.59 (0.41 to 0.81) | 0.64 (0.51 to 0.79) | 0.27 (0.15 to 0.42) | 0.20 (0.10 to 0.33) | 0.27 (0.10 to 0.52) | 0.31 (0.12 to 0.58) |
Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| SAF-M1 Placebo | — | — | — |
| SAF-M1 Empagliflozin 10 mg | — | — | — |
| SAF-M1 Empagliflozin 25 mg | — | — | — |
| SAF-M2 Placebo | — | — | — |
| SAF-M2 Empagliflozin 10 mg | — | — | — |
| Trial NCT01131676: Placebo | — | — | — |
| Trial NCT01131676: Empagliflozin 10 mg | — | — | — |
| Trial NCT01131676: Empagliflozin 25 mg | — | — | — |
| Trial NCT03057977: Placebo | — | — | — |
| Trial NCT03057977: Empagliflozin 10 mg | — | — | — |
| Trial NCT03057951: Placebo | — | — | — |
| Trial NCT03057951: Empagliflozin 10 mg | — | — | — |
Treated Set (TS): Patients treated with at least 1 dose of study medication.
| Age, Continuous(Years) | Trial NCT01131676: Placebo | Trial NCT01131676: Empagliflozin 10 mg | Trial NCT01131676: Empagliflozin 25 mg | Trial NCT03057951: Placebo | Trial NCT03057951: Empagliflozin 10 mg | Trial NCT03057977: Placebo | Trial NCT03057977: Empagliflozin 10 mg | Total |
|---|---|---|---|---|---|---|---|---|
| Mean | 63.2 ± 8.8 | 63.0 ± 8.6 | 63.2 ± 8.6 | 71.9 ± 9.6 | 71.8 ± 9.3 | 66.5 ± 11.2 | 67.2 ± 10.8 | 67.1 ± 10.2 |
| Sex: Female, Male(Participants) | Trial NCT01131676: Placebo | Trial NCT01131676: Empagliflozin 10 mg | Trial NCT01131676: Empagliflozin 25 mg | Trial NCT03057951: Placebo | Trial NCT03057951: Empagliflozin 10 mg | Trial NCT03057977: Placebo | Trial NCT03057977: Empagliflozin 10 mg | Total |
|---|---|---|---|---|---|---|---|---|
| Female | 653 | 692 | 659 | 1336 | 1338 | 453 | 437 | 5568 |
| Male | 1680 | 1653 | 1683 | 1653 | 1658 | 1410 | 1426 | 11163 |
| Ethnicity (NIH/OMB)(Participants) | Trial NCT01131676: Placebo | Trial NCT01131676: Empagliflozin 10 mg | Trial NCT01131676: Empagliflozin 25 mg | Trial NCT03057951: Placebo | Trial NCT03057951: Empagliflozin 10 mg | Trial NCT03057977: Placebo | Trial NCT03057977: Empagliflozin 10 mg | Total |
|---|---|---|---|---|---|---|---|---|
| Hispanic or Latino | 418 | 432 | 415 | 753 | 770 | 613 | 616 | 4017 |
| Not Hispanic or Latino | 1912 | 1909 | 1926 | 2235 | 2226 | 1175 | 1164 | 12547 |
| Unknown or Not Reported | 3 | 4 | 1 | 1 | 0 | 75 | 83 | 167 |
| Race (NIH/OMB)(Participants) | Trial NCT01131676: Placebo | Trial NCT01131676: Empagliflozin 10 mg | Trial NCT01131676: Empagliflozin 25 mg | Trial NCT03057951: Placebo | Trial NCT03057951: Empagliflozin 10 mg | Trial NCT03057977: Placebo | Trial NCT03057977: Empagliflozin 10 mg | Total |
|---|---|---|---|---|---|---|---|---|
| American Indian or Alaska Native | 20 | 11 | 23 | 104 | 90 | 24 | 15 | 287 |
| Asian | 511 | 505 | 501 | 411 | 413 | 334 | 337 | 3012 |
| Native Hawaiian or Other Pacific Islander | 4 | 3 | 3 | 19 | 14 | 6 | 8 | 57 |
| Black or African American | 120 | 119 | 118 | 125 | 133 | 134 | 123 | 872 |
| White | 1678 | 1707 | 1696 | 2254 | 2285 | 1301 | 1325 | 12246 |
| More than one race | 0 | 0 | 0 | 75 | 60 | 33 | 28 | 196 |
| Unknown or Not Reported | 0 | 0 | 1 | 1 | 1 | 31 | 27 | 61 |
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Plan to share: No — Clinical studies sponsored by Boehringer Ingelheim, phases I to IV, interventional and non-interventional, are in scope for sharing of the raw clinical study data and clinical study documents. Exceptions might apply, e.g. studies in products where Boehringer Ingelheim is not the license holder; studies regarding pharmaceutical formulations and associated analytical methods, and studies pertinent to pharmacokinetics using human biomaterials; studies conducted in a single center or targeting rare diseases (in case of low number of patients and therefore limitations with anonymization). For more details refer to: https://www.mystudywindow.com/msw/datatransparency
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