Comparison of Empagliflozin and Dapagliflozin for Type 2 Diabetes
Both empagliflozin (Jardiance) and dapagliflozin (Farxiga) have similar cardiovascular and renal outcomes in patients with type 2 diabetes, with no significant differences in major cardiovascular events, heart failure hospitalization, or serious renal events. 1
Mechanism of Action
- Both medications are SGLT2 (sodium-glucose cotransporter-2) inhibitors that work by blocking glucose reabsorption in the kidneys, increasing urinary glucose excretion and reducing hyperglycemia 2, 3
- Both medications offer the convenience of once-daily oral administration with a low inherent risk of hypoglycemia due to their insulin-independent mechanism of action 2
Efficacy Comparison
- Empagliflozin demonstrates slightly greater HbA1c reduction (-1.7±0.9%) compared to dapagliflozin (-1.2±1.4%) when used as add-on therapy 4
- Empagliflozin shows more significant reduction in fasting blood sugar (-75.6±43.5 mg/dl) compared to dapagliflozin (-63.5±60.5 mg/dl) 4
- Both medications provide similar weight reduction benefits, though empagliflozin showed slightly greater weight reduction (-2.9±6.4 kg vs -1.7±2.4 kg) in direct comparison studies 4
Cardiovascular Benefits
- Empagliflozin demonstrated a 38% reduction in cardiovascular death and 35% reduction in heart failure hospitalization in the EMPA-REG OUTCOME trial 5
- Dapagliflozin showed a 27% reduction in heart failure hospitalization in DECLARE-TIMI 58 and significant benefits in the DAPA-HF trial 5
- A large-scale Scandinavian cohort study found no significant differences between empagliflozin and dapagliflozin for major cardiovascular events (HR 1.02), heart failure outcomes (HR 1.05), or cardiovascular death (HR 1.01) 1
- A recent network meta-analysis found dapagliflozin superior to empagliflozin in preventing atrial fibrillation, but no significant differences in other cardiovascular outcomes 6
Heart Failure Benefits
- Both medications have proven benefits in heart failure patients regardless of diabetes status 7
- Dapagliflozin reduced the composite of cardiovascular death or heart failure hospitalization by approximately 25% in the DAPA-HF trial 7
- Empagliflozin showed a 21% reduction in the composite of cardiovascular death or hospitalization for worsening heart failure in EMPEROR-Reduced 7
- Both medications are effective in heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) 7
Renal Benefits
- Both medications offer renoprotective effects, especially in patients with albuminuria 5
- In comparative studies, empagliflozin showed a slightly lower risk of requiring renal replacement therapy (HR 0.77) compared to dapagliflozin, though overall serious renal events were similar 1
Safety Profile
- Both medications have similar overall safety profiles 1, 4
- Dapagliflozin has higher rates of urinary tract infections (7.08% vs 2.34%) and genital infections (8.66% vs 3.1%) compared to empagliflozin 4
- Neither medication is associated with increased risk of diabetic ketoacidosis when compared to each other 1
Specific Indications
- For patients with established atherosclerotic cardiovascular disease (ASCVD), both medications provide cardiovascular protection 5
- For patients with heart failure (regardless of ejection fraction), both dapagliflozin and empagliflozin are recommended based on dedicated heart failure trials 5
- For patients with diabetic kidney disease, both medications offer renoprotective benefits 5
Practical Considerations
- Both medications should be used with caution in patients with renal insufficiency (GFR < 45 mL/min/1.73 m²) 8
- The benefits of both medications appear to be a class effect and are largely independent of glycemic control 7
In conclusion, while empagliflozin may offer slightly better glycemic control and lower rates of urogenital infections, and dapagliflozin may provide better protection against atrial fibrillation, the overall cardiovascular and renal outcomes are remarkably similar between these two SGLT2 inhibitors.