Although dapagliflozin (Farxiga) and empagliflozin (Jardiance) show similar cardiorenal and safety outcomes for patients with type 2 diabetes (T2D), unstable prior angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) use could be a factor in the mortality risk of patients receiving empagliflozin.1
However, caution with empagliflozin use should be taken for patients who were previously on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. | Image Credit: irissca – stock.adobe.com
“Both dapagliflozin and empagliflozin demonstrated statistically comparable cardiorenal benefits and safety outcomes, with consistent results across various sensitivity analyses and prespecified subgroups,” the authors said.1 “In the sensitivity analysis focusing on unstable prior ACEI/ARB exposure, empagliflozin use was associated with an increased risk of all-cause death compared to dapagliflozin.”
T2D is a complex disease, with treatment often including physical activity, diet changes, and oral or injectable medications to help meet blood glucose goals. Common symptoms can include urinating often, feeling thirsty, extreme fatigue, blurry vision, and cuts and bruises that are slow to heal. However, sometimes symptoms are so mild that they are often unrecognized, according to the American Diabetes Association.2 Preventing T2D and treating the condition early can help prevent or reduce the risk of cardiovascular events and chronic kidney disease.
Dapagliflozin is an oral treatment that helps the kidney prevent absorption of glucose and can lower blood sugar. Further, it can be used to lower the risk of hospitalization for heart failure, other cardiovascular diseases, and kidney diseases.3 Empagliflozin works similarly, as it also helps to prevent absorption of glucose. It is also used to lower the risk of cardiovascular disease for patients with T2D and heart or blood vessel diseases. It can also be used to lower the risk of cardiovascular death and hospitalization for patients with heart failure as well as lower the risk for worsening kidney disease.4
In the current study, investigators gathered multi-institutional electronic health records to analyze the cardiorenal and safety outcomes as well as prescribing patterns of both medications for patients with T2D. They aimed to create a comprehensive real-world view of the effectiveness of the medications. Investigators used data from January 2016 to August 2023, and patients included were 18 years and older with T2D and an estimated glomerular filtration rate (eGFR) ≥25 mL/min/1.73 m2 who recently initiated dapagliflozin or empagliflozin.1
Between the study dates, a total of 4695 patients met the eligibility criteria for the analysis, with 2649 starting dapagliflozin and 2046 starting empagliflozin. Investigators established 1662 matched pairs. The primary outcome—sustained eGFR decline of 30% or more, end-stage renal disease, hospitalization for heart failure, or all-cause death—occurred in 16.2% of patients in both groups, and there were no differences found in composite renal outcome, hospitalization from any cause, and all-cause death. Additionally, the incidence of adverse events was similar between both groups, including acute kidney injury, hypoglycemia, urinary tract infection, and fracture. Cardiologists prescribed dapagliflozin more often, and endocrinologists and nephrologists prescribed empagliflozin more often.1
Furthermore, investigators found that patients with at least 1 ACEI/ARB prescription prior to the index date were associated with higher all-cause mortality when taking empagliflozin compared with dapagliflozin, and the association was seen regardless of treatment duration or continuous use.1
“These findings suggested that dapagliflozin and empagliflozin may be interchangeable treatment options in most clinical scenarios,” the authors said.1 “However, caution may be warranted when prescribing empagliflozin to patients with unstable use of prior ACEI/ARB treatment. Additionally, this study provided novel insights into specialty-driven prescribing behaviors for dapagliflozin and empagliflozin.”
READ MORE: Diabetes Resource Center
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