Dapagliflozin Comparable with Empagliflozin for Long-Term Kidney Outcomes in T2D

Patients with type 2 diabetes (T2D) exhibited similar outcomes when prescribed either empagliflozin or dapagliflozin for treating chronic kidney disease (CKD), according to data published in JAMA Internal Medicine.¹ With study results showing neither drug is more effective than the other within this population, researchers agree with the current practice of not recommending either drug over the other.

“The sodium-glucose cotransporter 2 inhibitors (SGLT2is) empagliflozin and dapagliflozin reduce cardiovascular and kidney outcomes in patients with [T2D]; thus, they are widely used,” wrote authors of the study. “The effects of SGLT2is are generally considered class effects. Consequently, Danish, European, and US guidelines do not favor any agent vs others when treating [T2D].”

T2D is a leading cause of CKD and both diseases are significantly prominent globally. | image credit: Anastasiia / stock.adobe.com

There is a slew of data showing that T2D is a leading cause of CKD, and both diseases are significantly prominent across the world. Indeed, the global diabetes burden is estimated at over 450 million patients,² while the global CKD burden is well over 800 million patients.³ Since many patients with T2D experience CKD and other cardiovascular-related complications,¹ researchers have continuously worked to better understand the efficacy of SGLT2is and the best clinical recommendations for using them to treat patients’ T2D.

“This prospective new-user, active-comparator cohort study used nationwide, population-based routinely collected Danish health care data to emulate a target trial (ie, a hypothetical pragmatic trial that would address the causal question of interest) of empagliflozin vs dapagliflozin, in addition to standard care, for preventing kidney outcomes in persons with [T2D],” they continued.¹

READ MORE: Q&A: Pharmacists’ Understanding of CKD Therapies, Adverse Effects | ASHP Midyear

Researchers’ main goal was to compare empagliflozin with dapagliflozin and determine the similarities and differences in kidney outcomes for patients with T2D previously receiving antihyperglycemic treatment. To do so, they collected patient data from June 1, 2014, to October 31, 2020, and searched for specific outcomes among the population, including acute kidney injury, incident CKD, and progression of CKD.

The group of patients with T2D receiving empagliflozin was more robust than those receiving dapagliflozin. However, the characteristics of each group were rather similar. The empagliflozin group contained a total of 32,819 individuals (median age, 62.6; 37.1% women) while the dapagliflozin cohort included 17,464 (median age, 62.7; 38.3% women). Patients’ HbA_1c levels and duration of diabetes were also significantly similar in both groups.

“In this nationwide cohort study, using the target trial emulation framework, we found no clinically important differences in 6-year kidney outcomes in persons with type 2 diabetes initiating treatment with empagliflozin or dapagliflozin,” they wrote.¹

Researchers noted that large clinical trials directly comparing the 2 medications in treating kidney outcomes are considerably lacking. However, after conducting their emulation of a clinical trial comparing the 2, they agree that their study is the best evidence in existence highlighting what decisions clinicians should be making when prescribing SGLT2is for patients with T2D.

While researchers ultimately did not find an SGLT2i that stands above the rest for treating CKD in patients with T2D, they hope the data can better inform clinicians going forward as more clinical research is released. For clinicians, and pharmacists as well, the comparability between empagliflozin and dapagliflozin can serve as an example for how each patients’ disease state is different from others. With the help of this data, all providers can now make better informed decisions.

“The results of this cohort study suggest that people with [T2D] who initiated treatment with empagliflozin and dapagliflozin had comparable long-term kidney outcomes. These findings support the current clinical practice of not recommending either drug vs the other when used for treating [T2D],” concluded authors of the study.¹

READ MORE: Diabetes Resource Center

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References

1. Bonnesen K, Heide-Jørgensen U, Christensen DH, et al. Effectiveness of empagliflozin vs dapagliflozin for kidney outcomes in type 2 diabetes. JAMA Intern Med. Published online January 21, 2025. doi:10.1001/jamainternmed.2024.7381

2. Khan MAB, Hashim MJ, King JK, et al. Epidemiology of type 2 diabetes: Global burden of disease and forecasted trends. J Epidemiol Glob Health. 2020 Mar;10(1):107-111. doi: 10.2991/jegh.k.191028.001.

3. Kovesdy CP. Epidemiology of chronic kidney disease: An update 2022. KI Supplements. 2022;12(1):7-11. doi.org/10.1016/j.kisu.2021.11.003