Comparison of cardiovascular and renal outcomes between dapagliflozin and empagliflozin in patients with type 2 diabetes

Abstract

Background: The 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. Therefore, we aimed to compare the clinical outcomes between dapagliflozin and empagliflozin in patients with type 2 diabetes without prior atherosclerotic cardiovascular disease, chronic kidney disease, or heart failure. 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 dipeptidyl peptidase-4 inhibitors (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 heart failure 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 atherosclerotic cardiovascular events, heart failure hospitalization, and renal events, compared to that with DPP4i use. There were no significant differences in clinical outcomes between dapagliflozin and empagliflozin, supporting a SGLT2i class effect.

Comparison of Cardiovascular Outcomes Between Dapagliflozin and Empagliflozin in Patients With Type 2 Diabetes: A Meta-Analysis

“…After removing duplicates, the title and abstracts of 207 articles were screened based on inclusion criteria. Overall, 22 articles were eligible for full-text screening, and finally, four studies were included in this meta-analysis [11][12][13][14]. The PRISMA flow chart is shown in Figure 1.…”

“…Overall, four studies compared the risk of myocardial infarction between two groups [11][12][13][14]. In patients with type 2 diabetes, the risk of MI was not significantly different between patients who received dapagliflozin and patients who received empagliflozin (risk ratio (RR)=0.81, 95% confidence interval (CI): 0.60-1.09).…”

“…Sources: References 11-14 [11][12][13][14] Four studies were analyzed to assess the effects of dapagliflozin and empagliflozin on the risk of heart failure in patients with type 2 diabetes [11][12][13][14]. No significant difference in risk of heart failure was there between dapagliflozin and empagliflozin (RR=0.76, 95% CI: 0.56-1.04).…”

“…There was no substantial heterogeneity across studies (I 2 =0%) as shown in Figure 3. Three studies were employed to compare the effects of dapagliflozin and empagliflozin on the risk of cardiovascular mortality [11][12][13]. No significant difference was found in the risk of cardiovascular mortality in the dapagliflozin group compared with the empagliflozin group in patients with type 2 diabetes (RR=0.46, 95% CI: 0.18-1.20).…”

“…Sources: References 11-13 [11][12][13] Three studies were employed to compare the effects of dapagliflozin and empagliflozin on the risk of stroke [11,[13][14]. The risk of stroke was not significantly different in type 2 diabetic patients who received dapagliflozin and who received empagliflozin (RR=1.07, 95% CI: 0.84-1.38).…”