Which is superior, dapagliflozin (Dapagliflozin) or empagliflozin (Empagliflozin), in terms of efficacy and safety?

From the Guidelines

Dapagliflozin is superior to empagliflozin in terms of efficacy and safety, particularly in reducing the risk of cardiovascular death and hospitalization for heart failure, as demonstrated in the most recent and highest quality study 1. When considering the treatment of type 2 diabetes, both dapagliflozin and empagliflozin are effective SGLT2 inhibitors with similar benefits and safety profiles. However, the latest evidence suggests that dapagliflozin has a more pronounced effect on reducing cardiovascular death and hospitalization for heart failure, with a 25% reduction in the composite of cardiovascular death or HF hospitalization, and a 30% reduction in HF hospitalization 1. Key points to consider when choosing between these medications include:

• Dapagliflozin has shown particular benefits in heart failure, including in patients without diabetes, with a significant reduction in cardiovascular death and all-cause mortality 1.
• Empagliflozin has robust evidence for reducing cardiovascular death, but the latest study suggests that dapagliflozin may have a more pronounced effect on this outcome 1.
• Both medications work by preventing glucose reabsorption in the kidneys, leading to increased glucose excretion in urine and lowered blood sugar levels.
• Common side effects for both include genital mycotic infections and increased urination.
• The choice between them often depends on specific patient factors, formulary considerations, and sometimes subtle differences in their approved indications. In terms of dosing, the recommended dose for dapagliflozin is 10 mg PO daily, while the recommended dose for empagliflozin is also 10 mg PO daily 1. It is essential to consider the patient's individual needs and medical history when selecting between these medications, as well as to monitor for potential adverse effects, such as genital fungal infections and urinary tract infections 1. Ultimately, dapagliflozin is the preferred choice for patients with type 2 diabetes, especially those with or at risk for cardiovascular or kidney disease, due to its superior efficacy and safety profile, as demonstrated in the most recent and highest quality study 1.

From the Research

Efficacy Comparison

• Dapagliflozin and empagliflozin have been compared in terms of their efficacy in treating type 2 diabetes mellitus, with studies suggesting that both medications are effective in improving glycemic control, promoting weight loss, and lowering blood pressure 2, 3.
• A comparative effectiveness study found that dapagliflozin and empagliflozin had comparable cardiovascular effectiveness, although low-dose dapagliflozin showed a reduced benefit for heart failure hospitalization compared to empagliflozin 4.
• Empagliflozin has been shown to demonstrate reduced risk of major adverse cardiovascular events, primarily due to a significant reduction in cardiovascular mortality 2, 5.

Safety Comparison

• Both dapagliflozin and empagliflozin have been associated with a higher rate of genital mycotic infections compared to placebo, although dapagliflozin initiators had a lower risk of genital infections compared to empagliflozin initiators 4, 3.
• Dapagliflozin initiators also had a lower risk of diabetic ketoacidosis (DKA) compared to empagliflozin initiators 4.
• Empagliflozin has been associated with a lower risk of severe urinary tract infections (UTIs) compared to canagliflozin, but a higher risk compared to dapagliflozin 4.

Overall Comparison

• The available evidence suggests that both dapagliflozin and empagliflozin are effective and safe treatments for type 2 diabetes mellitus, although they may have different benefits and risks in certain patient populations 2, 4, 3, 5, 6.
• Empagliflozin may have a more favorable cardiovascular risk profile, although dapagliflozin may have a lower risk of certain adverse events such as genital infections and DKA 4.