Empagliflozin and dapagliflozin have comparable long-term kidney outcomes in Type 2 Diabetes: JAMA
The results of this cohort study suggest that individuals with type 2 diabetes who initiated treatment with empagliflozin or dapagliflozin had comparable long-term kidney outcomes. These findings support the current clinical practice of not recommending one drug over the other for the treatment of type 2 diabetes.
No large randomized clinical trial has directly compared empagliflozin with dapagliflozin, leaving their comparative effectiveness regarding kidney outcomes unknown. A study was done to compare kidney outcomes between initiation of empagliflozin vs dapagliflozin in adults with type 2 diabetes who were receiving antihyperglycemic treatment.
This target trial emulation used nationwide, population-based routinely collected Danish health care data to compare initiation of empagliflozin vs dapagliflozin in adults with type 2 diabetes who received antihyperglycemic treatment between June 1, 2014, and October 31, 2020. Data were analyzed from October 2023 to August 2024.
Persons were followed up until an outcome, emigration, death, 6 years, or December 31, 2021, whichever occurred first. Outcomes included acute kidney injury, incident chronic kidney disease (stages G3 to G5 or stage A2 or A3), and progression of chronic kidney disease (≥40% decrease in estimated glomerular filtration rate from baseline). Risks of kidney outcomes were estimated in intention-to-treat and per-protocol analyses using an Aalen-Johansen estimator that adjusted for 56 potential confounders and considered death as a competing event.
Results A total of 32 819 individuals who initiated treatment with empagliflozin and 17 464 with dapagliflozin were included (median [IQR] age, 63 [54-71] years; 18 872 female individuals [37.5%]; median [IQR] estimated glomerular filtration rate, 88 [73-104] mL/min/1.73 m2). After weighting, all measured covariates were well balanced between the groups. In intention-to-treat analyses, people who initiated treatment with empagliflozin and dapagliflozin exhibited comparable 6-year risks of acute kidney injury chronic kidney disease stages G3 to G5, chronic kidney disease stage A2 or A3, and progression of chronic kidney disease.
The primary analyses were supported by corresponding per-protocol analyses. The results of this cohort study suggest that people with type 2 diabetes who initiated treatment with empagliflozin and dapagliflozin had comparable long-term kidney outcomes.
Reference:
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
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