Journal Article

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

Choi, Hong-Mi, Cho, Goo-Yeong, Yoon, Yeonyee E., Hwang, In-Chang, Lim, Jayoung

2022

Overview

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. 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. 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. 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.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acute coronary syndromes / Age / Antidiabetics / Arteriosclerosis / Atherosclerosis / Benzhydryl Compounds - therapeutic use / Biology and Life Sciences / Blood pressure / Cardiovascular disease / Cardiovascular diseases / Cardiovascular Diseases - complications / Care and treatment / Cholesterol / Chronic kidney failure / Clinical outcomes / Complications and side effects / Confidence intervals / Congestive heart failure / Coronary artery disease / Coronary heart disease / Dapagliflozin / Diabetes / Diabetes mellitus / Diabetes mellitus (non-insulin dependent) / Diabetes Mellitus, Type 2 - complications / Diabetes Mellitus, Type 2 - drug therapy / Diabetes Mellitus, Type 2 - epidemiology / Dipeptidyl-Peptidase IV Inhibitors - therapeutic use / Dosage and administration / Endocrine system / Glomerular filtration rate / Glucose / Glucose transporter / Glucosides / Glycated Hemoglobin - analysis / Heart diseases / Heart failure / Heart Failure - complications / Hemoglobin / Humans / Hypertension / Hypoglycemic Agents - therapeutic use / Inhibitors / Ischemia / Kidney diseases / Laboratories / Lipoproteins, LDL / Medicine and Health Sciences / Patients / Peptidase / Peptidases / Prevention / Renal failure / Renal Insufficiency, Chronic - chemically induced / Renal Insufficiency, Chronic - complications / Renal Insufficiency, Chronic - drug therapy / Retrospective Studies / Risk factors / Risk management / Sodium / Sodium-Glucose Transporter 2 Inhibitors - therapeutic use / Type 2 diabetes