From the Guidelines
Dapagliflozin and empagliflozin are both effective in reducing the composite of cardiovascular death or heart failure hospitalization in patients with heart failure with reduced ejection fraction (HFrEF), but dapagliflozin has a more significant reduction in all-cause mortality, as shown in the DAPA-HF trial 1. The key differences between the two medications include patient populations and specific outcomes.
- Dapagliflozin (DAPA-HF) and empagliflozin (EMPEROR-Reduced) both reduced the composite of cardiovascular death or heart failure hospitalization by approximately 25%, with the benefit appearing early and continuing throughout the trials.
- Both medications are dosed once daily (dapagliflozin 10mg, empagliflozin 10mg) and can be initiated in patients with eGFR ≥30 ml/min/1.73m².
- The mechanism of benefit likely involves improved cardiac energetics, reduced cardiac preload and afterload, and cardiorenal protective effects that extend beyond glycemic control, making these agents effective in both diabetic and non-diabetic patients with HFrEF, as supported by the 2024 standards of care in diabetes 1.
- A large recent meta-analysis of data from EMPEROR-Reduced, EMPEROR-Preserved, DAPA-HF, DELIVER, and the Effect of Sotagliflozin on Cardiovascular Events in Patients With Type 2 Diabetes Post Worsening Heart Failure (SOLOIST-WHF) trial included 21,947 individuals and demonstrated reduced risk for the composite of cardiovascular death or hospitalization for heart failure, cardiovascular death 1.
- The 2022 AHA/ACC/HFSA guideline for the management of heart failure also supports the use of SGLT2 inhibitors in patients with HFrEF, regardless of the presence or absence of diabetes 1.
- In terms of quality of life, empagliflozin resulted in a modest improvement in QOL at 52 weeks, as shown in the EMPEROR-Preserved trial 1.
- Overall, dapagliflozin is recommended as the first-line SGLT2 inhibitor for patients with HFrEF, due to its significant reduction in all-cause mortality, as shown in the DAPA-HF trial 1.
From the Research
DAPA HF vs Emperor Reduced Comparative
- The DAPA-HF trial demonstrated that dapagliflozin markedly reduces the risk of HF hospitalization and improves prognosis in patients with heart failure and reduced ejection fraction 2.
- The study found that dapagliflozin reduced the risk of worsening heart failure or cardiovascular death by 26% compared to placebo, with a hazard ratio of 0.74 (95% CI, 0.65 to 0.85; P<0.001) 2.
- The benefits of dapagliflozin were consistent regardless of the presence or absence of type 2 diabetes, with similar reductions in worsening heart failure and cardiovascular death observed in both patient groups 2.
- A subsequent analysis of the DAPA-HF trial found that dapagliflozin improved all outcomes examined, including HF hospitalization, cardiovascular death, all-cause mortality, and improvement in the Kansas City Cardiomyopathy Questionnaire total symptom score (KCCQ-TSS), regardless of the modified Heart Failure Collaboratory (HFC) score 3.
- The Emperor Reduced trial is not directly mentioned in the provided evidence, but the DAPA-HF trial provides significant insights into the efficacy and safety of dapagliflozin in patients with heart failure and reduced ejection fraction 4, 5, 6.
- Overall, the available evidence suggests that dapagliflozin is an effective and generally well-tolerated treatment for patients with heart failure and reduced ejection fraction, with significant reductions in worsening heart failure and cardiovascular death observed in clinical trials 4, 5, 6, 2.