Comparison of cardiovascular and renal outcomes between dapagliflozin and empagliflozin in patients with type 2 diabetes without prior cardiovascular or renal disease

Abstract

Background Cardiovascular and renal benefits of sodium glucose co-transporter 2 inhibitors (SGLT2i) have been clearly demonstrated. However, studies comparing the effects of dapagliflozin and empagliflozin are scarce. In addition, relatively few studies have analyzed the effects of SGLT2i in diabetic patients without established atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), or heart failure (HF), and current guidelines recommend SGLT2i and other antidiabetic drugs equally in this population. Therefore, we aimed to compare the clinical outcomes between dapagliflozin, empagliflozin, and dipeptidyl peptidase-4 inhibitors (DPP4i) in patients with type 2 diabetes without prior ASCVD, CKD, or HF. Methods Using a propensity-score matching method, we retrospectively analyzed 921 patients treated with dapagliflozin, 921 patients treated with empagliflozin, and 1842 patients treated with DPP4i (control group). Study outcomes comprised composite coronary events (acute coronary syndrome and coronary revascularization), composite ischemic events (coronary events and stroke), and composite heart failure and renal events. Results During follow up (median, 43.4 months), the incidence of composite coronary events was significantly lower in the SGLT2i groups than in the control group, and the incidence of composite ischemic events was lower in the dapagliflozin group than in the control group. Dapagliflozin and empagliflozin both demonstrated significant benefits in terms of HF and renal outcomes, supported by renoprotective effects, as assessed by the change in glomerular filtration rate. At 24–36 months of treatment, the empagliflozin group had higher low-density lipoprotein cholesterol levels, and lower glycated hemoglobin levels, compared to those in the dapagliflozin and control groups. Conclusion SGLT2i use was associated with a significantly reduced risk of ASCVD, HF hospitalization, and renal events, compared to that with DPP4i use among diabetic patients without prior ASCVD, CKD, or HF. There were no significant differences in clinical outcomes between dapagliflozin and empagliflozin, supporting a SGLT2i class effect.

Cardiovascular outcomes between dapagliflozin versus empagliflozin in patients with diabetes mellitus

“…The results from this presented study were in agreement with several studies, which found no significant differences in cardiovascular outcomes between dapagliflozin and empagliflozin. 17 , 18 , 19 , 20 These findings suggested a class of SGLT2 inhibitors in managing cardiovascular risks in DM patients, irrespective of the specific SGLT2 inhibitors used. However, contrasting outcomes have been observed in some studies.…”

Sodium-glucose cotransporter 2 inhibitor may not prevent atrial fibrillation in patients with heart failure: a systematic review

“…Among all trails included, the heaviest weight of the statistical analysis depended on EMPEROR-preserved, where empagliflozin proved to be more effective in reducing the risk of exacerbation of HF than dapagliflozin [ 53 ]. Furthermore, the empagliflozin group had more significant beneficial effects on high-density lipoprotein (HDL) and low-density lipoprotein (LDL) and lower glycated hemoglobin levels than dapagliflozin [ 54 , 55 ]. Interestingly, we found that empagliflozin present an effective role in reducing the risk of AF after removing EMPEROR-preserved in the sensitivity analysis.…”

Peran SGLT2i terhadap Risiko Kardiorenal Pasien dengan atau Tanpa Diabetes Melitus Tipe 2

“…15,16 Kedua kelompok juga terbukti menurunkan angka kejadian kematian kardiovaskular, tekanan darah, gagal jantung, ataupun kematian karena semua sebab; penurunan kematian kardiovaskular dan tekanan darah lebih signifikan pada kelompok empagli ozin, sedangkan penurunan risiko hospitalisasi gagal jantung lebih signifikan pada kelompok dapagli ozin. 15,[19][20][21][22][23] Yang, et al, menyatakan fungsi ginjal pada kelompok empagli ozin menunjukkan tren penurunan fungsi, sedangkan pada kelompok dapagli ozin menunjukkan tren perbaikan fungsi. Walau tidak sebaik dapagli ozin, empagli ozin tetap menurunkan risiko gagal ginjal lebih baik bila dibandingkan plasebo.…”

“…Walau tidak sebaik dapagli ozin, empagli ozin tetap menurunkan risiko gagal ginjal lebih baik bila dibandingkan plasebo. 17,21 Manfaat dapagli ozin dan empagli ozin pada pasien DM tipe 2 juga dapat dilihat pada penelitian DECLARE-TIMI 58 dan EMPA-REG. Penelitian DECLARE-TIMI 58 bertujuan untuk mengevaluasi dampak kardiovaskular dan ginjal dapagli ozin versus plasebo pada 17.160 pasien DM tipe 2 yang memiliki atau berisiko ASCVD.…”