From the Guidelines
Empagliflozin (Jardiance) has demonstrated a significant benefit in reducing heart failure hospitalizations and improving quality of life, making it a preferable choice over Dapagliflozin (Farxiga) in patients with heart failure with preserved ejection fraction, as shown in the EMPEROR-Preserved trial 1. The EMPEROR-Preserved trial, published in 2022, found that empagliflozin resulted in a 21% reduction in the primary composite endpoint of time to heart failure hospitalization or cardiovascular death, driven mostly by a 29% reduction in time to heart failure hospitalization 1. Key benefits of empagliflozin include:
- Significant reduction in total heart failure hospitalizations
- Decrease in the slope of the eGFR decline
- Modest improvement in quality of life at 52 weeks
- Benefit similar irrespective of the presence or absence of diabetes at baseline In contrast, while dapagliflozin has demonstrated benefits in heart failure and chronic kidney disease, the most recent and highest quality evidence supports the use of empagliflozin in patients with heart failure with preserved ejection fraction 1. When considering the choice between empagliflozin and dapagliflozin, it is essential to individualize the decision based on the patient's comorbidities, insurance coverage, and specific treatment goals.
From the Research
Comparative Efficacy of Empagliflozin and Dapagliflozin
- The comparative efficacy of Empagliflozin (Jardiance) and Dapagliflozin (Farxiga) has been studied in several research papers 2, 3, 4, 5, 6.
- A study published in JAMA network open found that patients who initiated empagliflozin were less likely to experience the composite of all-cause mortality or hospitalization compared with patients who started dapagliflozin (HR, 0.90 [95% CI, 0.86-0.94]) 2.
- Another study published in Frontiers in cardiovascular medicine found that dapagliflozin was comparable with empagliflozin in hospitalization for heart failure, but empagliflozin decreased the risk of exacerbation of heart failure over dapagliflozin (OR=0.70,95%CI: 0.59-0.84) 3.
- A study published in JAMA internal medicine found that individual SGLT-2 inhibitors demonstrated comparable cardiovascular effectiveness at clinically effective doses, though low-dose dapagliflozin showed a reduced benefit for heart failure hospitalization compared with empagliflozin 4.
- A retrospective study published in Clinical cardiology found that there was no significant difference between the dapagliflozin and empagliflozin groups in the risk of major adverse cardiovascular events (MACE) (HR, 1.31; 95% CI, 0.73-2.35; p = 0.349) 5.
- A meta-analysis published in Annals of translational medicine found that empagliflozin reduces all-cause mortality and cardiovascular mortality in patients with established cardiovascular disease and type 2 diabetes, but there are no differences in cardiovascular morbidity and mortality and all-cause mortality between empagliflozin and other antidiabetic drugs 6.
Key Findings
- Empagliflozin may have a slightly better efficacy profile compared to dapagliflozin in terms of reducing the composite of all-cause mortality or hospitalization 2.
- Dapagliflozin may be comparable to empagliflozin in terms of hospitalization for heart failure, but empagliflozin may have a better efficacy profile in terms of reducing the risk of exacerbation of heart failure 3.
- Individual SGLT-2 inhibitors, including empagliflozin and dapagliflozin, demonstrate comparable cardiovascular effectiveness at clinically effective doses 4.
- There is no significant difference in the risk of major adverse cardiovascular events between dapagliflozin and empagliflozin 5.
- Empagliflozin reduces all-cause mortality and cardiovascular mortality in patients with established cardiovascular disease and type 2 diabetes 6.