From the Guidelines
Forxiga (dapagliflozin) is generally preferred over Trajenta (linagliptin) for patients with type 2 diabetes and cardiovascular disease or heart failure, as it offers cardiovascular benefits and can reduce hospitalization for heart failure, as shown in the DAPA-HF trial 1. The choice between Forxiga and Trajenta depends on the patient's specific health profile.
- For patients with cardiovascular disease or heart failure, Forxiga is typically started at 10 mg once daily, taken in the morning.
- Forxiga works by increasing glucose excretion through the kidneys, which also provides modest weight loss and blood pressure reduction benefits.
- However, it should be avoided in patients with recurrent urinary tract infections or genital mycotic infections.
- Trajenta works by increasing insulin secretion and decreasing glucagon, making it weight-neutral and having minimal risk of hypoglycemia.
- The medication choice should ultimately be individualized based on comorbidities, kidney function, risk of side effects, and cost considerations after discussion with a healthcare provider. According to the 2022 AHA/ACC/HFSA guideline for the management of heart failure, SGLT2 inhibitors like Forxiga are recommended as first-line agents for the treatment of hyperglycemia in patients with diabetes with heart failure or at high risk of heart failure 1. Additionally, the 2020 expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes recommends Forxiga as a treatment option for patients with established cardiovascular disease or multiple cardiovascular risk factors 1. The 2022 standards of medical care in diabetes also support the use of SGLT2 inhibitors like Forxiga for patients with type 2 diabetes and established cardiovascular disease or multiple cardiovascular risk factors 1. Overall, the evidence suggests that Forxiga is a preferred treatment option for patients with type 2 diabetes and cardiovascular disease or heart failure, due to its cardiovascular benefits and ability to reduce hospitalization for heart failure.
From the Research
Comparison of Forxiga and Trajenta
- Forxiga (dapagliflozin) is a sodium-glucose co-transporter-2 (SGLT2) inhibitor used in the treatment of patients with type 2 diabetes, reducing renal glucose reabsorption and increasing urinary glucose excretion 2, 3, 4.
- Trajenta (linagliptin) is a dipeptidyl peptidase-4 (DPP-4) inhibitor, which is also used to treat type 2 diabetes, but its mechanism of action is different from Forxiga.
- Studies have shown that Forxiga provides effective glycaemic control, reduces body weight and blood pressure, and has a low risk of hypoglycaemia 2, 3, 4.
- Forxiga has also been shown to have cardioprotective and possibly renoprotective properties, making it an important option for the management of a broad patient population with type 2 diabetes 4, 5.
- However, there are no direct comparisons between Forxiga and Trajenta in the provided evidence, making it difficult to determine a preferred treatment between the two.
Efficacy and Safety of Forxiga
- Forxiga has been consistently shown to reduce glycosylated haemoglobin values, fasting plasma glucose levels, and body weight in patients with type 2 diabetes 2, 3, 4.
- Forxiga is generally well tolerated, with a low risk of hypoglycaemia, but may cause genital mycotic infections and urinary tract infections 2, 3, 4.
- The efficacy and safety of Forxiga have been maintained over longer-term follow-up periods of up to 4 years 3, 4.
Limitations of the Evidence
- There are no studies directly comparing the efficacy and safety of Forxiga and Trajenta in the provided evidence.
- The evidence is limited to studies on Forxiga, and more research is needed to fully understand its effects compared to other treatments like Trajenta.