Which medication, Farxiga (dapagliflozin) or Jardiance (empagliflozin), has fewer side effects but better supports heart failure?

Comparing Farxiga (Dapagliflozin) and Jardiance (Empagliflozin) for Heart Failure Management

Both Farxiga (dapagliflozin) and Jardiance (empagliflozin) are highly effective for heart failure management with similar safety profiles, but Jardiance demonstrated a slightly greater reduction in heart failure hospitalization (35% vs 27%) in clinical trials and may be preferred for patients with heart failure with reduced ejection fraction.

Efficacy in Heart Failure Management

Heart Failure with Reduced Ejection Fraction (HFrEF)

• Jardiance (empagliflozin):

  • In EMPEROR-Reduced trial: 21% reduction in the composite of cardiovascular death or hospitalization for worsening heart failure (HR 0.79 [95% CI 0.69–0.90]; P < 0.001) 1
  • In EMPA-REG OUTCOME: 35% reduction in hospitalization for heart failure 1
  • Effective in NYHA class II-IV heart failure patients with ejection fraction ≤40% 1

• Farxiga (dapagliflozin):

  • In DAPA-HF trial: 26% reduction in the composite of worsening heart failure or cardiovascular death (HR 0.74 [95% CI 0.65–0.85]) 1
  • 30% reduction in first worsening heart failure event (HR 0.70 [95% CI 0.59–0.83]) 1
  • 18% reduction in cardiovascular death (HR 0.82 [95% CI 0.69–0.98]) 1
  • 27% reduction in hospitalization for heart failure in DECLARE-TIMI 58 1

Heart Failure with Preserved Ejection Fraction (HFpEF)

• Farxiga (dapagliflozin):

  • In DELIVER trial: 18% reduction in composite of worsening heart failure or cardiovascular death in patients with ejection fraction >40% (HR 0.82 [95% CI 0.73–0.92]; P < 0.001) 1, 2

• Jardiance (empagliflozin):

  • Demonstrated benefit in EMPEROR-Preserved trial for patients with heart failure with preserved ejection fraction (LVEF >40%) 1

Safety Profile and Side Effects

Common Side Effects for Both Medications

• Genital mycotic infections 1, 3
• Urinary tract infections 1, 3
• Volume depletion/hypotension 3
• Risk of euglycemic diabetic ketoacidosis (rare but serious) 1, 3

Specific Considerations

• Both medications have a low inherent risk of hypoglycemia when used as monotherapy 3
• Risk of hypoglycemia increases when combined with insulin or sulfonylureas 3
• Neither medication requires dose titration, making them easier to initiate than many other heart failure medications 1
• Both medications are effective regardless of diabetes status 1

Renal Function Considerations

• Farxiga (dapagliflozin):

  • Can be used with eGFR ≥20 mL/min/1.73m² 4
  • In DAPA-CKD trial: 39% reduction in the composite kidney outcome (HR 0.61 [95% CI 0.51-0.72]) 4

• Jardiance (empagliflozin):

  • Can be used with eGFR ≥30 mL/min/1.73m² 1
  • Also demonstrated renal protection benefits 1

Clinical Decision Algorithm

1. For patients with HFrEF (EF ≤40%):

   • Both medications are highly effective
   • Jardiance may be slightly preferred due to greater reduction in heart failure hospitalization (35% vs 27%)

2. For patients with HFpEF (EF >40%):

   • Both medications have demonstrated benefits
   • Farxiga has more robust evidence from the DELIVER trial specifically for this population

3. For patients with renal impairment:

   • For eGFR 20-30 mL/min/1.73m²: Farxiga is the only option
   • For eGFR ≥30 mL/min/1.73m²: Either medication is appropriate

4. For patients with history of genital infections:

   • Both medications carry similar risk; consider alternative heart failure therapies if recurrent infections are a concern

Important Clinical Considerations

• The benefits of both medications appear to be a class effect and are independent of glucose-lowering effects 1
• Effects are consistent regardless of the presence or absence of type 2 diabetes 1
• Benefits are seen early (within weeks) after drug initiation 1
• Both medications can be used alongside standard heart failure therapies including ACEi/ARBs, beta-blockers, and MRAs 1
• The 2022 AHA/ACC/HFSA guidelines recommend SGLT2 inhibitors for patients with HFrEF regardless of diabetes status 1

Conclusion

While both medications are highly effective for heart failure management with similar safety profiles, Jardiance demonstrated a slightly greater reduction in heart failure hospitalization in clinical trials. For patients with severely reduced renal function (eGFR 20-30 mL/min/1.73m²), Farxiga is the only option. The choice between these medications should be guided by specific patient factors including renal function, ejection fraction, and medication access.