Which is better in the treatment of heart failure, Empagliflozin or Dapagliflozin?

What is Empagliflozin?

Empagliflozin is a drug approved for the treatment of type 2 diabetes in adults. It acts in the kidneys by inhibiting sodium-glucose cotransporter protein-2 (SGLT-2), which reduces glucose reabsorption by the kidneys and increases urinary glucose excretion. It does not help patients with insulin-dependent or type 1 diabetes. In 2016, the FDA approved a new indication for empagliflozin, which is designed to reduce the risk of cardiovascular death in adult patients with type 2 diabetes and cardiovascular disease. It has also been shown to reduce hospitalisation for heart failure and death from cardiovascular causes.

What is Dapagliflozin?

Dapagliflozin is the first novel sodium-glucose co-transporter protein-2 (SGLT2) inhibitor approved by the European Medicines Agency (EMA) for the treatment of type 2 diabetes. Its mechanism of action is similar to that of Empagliflozin in that it works by inhibiting SGLT2. It is mainly used for the treatment of type 2 diabetes. It is also used to treat heart failure and chronic kidney disease (CKD).

Empagliflozin vs Dapagliflozin: heart failure

In summary, it can be seen that both Empagliflozin and Dapagliflozin belong to the category of antidiabetic drugs with similar mechanisms of action and both are mainly used to treat type 2 diabetes mellitus, but also can be used to treat heart failure.

Empagliflozin and dapagliflozin have demonstrated cardiovascular benefits in heart failure (HF) patients, reducing death and hospitalizations. A retrospective study indicates empagliflozin's potential superiority in cardiac remodeling and functional status over dapagliflozin. However, a meta-analysis reveals similar cardiovascular outcomes for both SGLT2 inhibitors, suggesting treatment differences may be due to adherence and comorbidities.

In a multicentre retrospective cohort study, 744 914 patients with heart failure and who had never previously taken an SGLT2 inhibitor and had just been started on either empagliflozin or dapagliflozin were collected.The results showed that compared with patients who were started on dapagliflozin, patients treated with empagliflozin were patients were less likely to experience all-cause mortality or hospitalisation (3545 [32.2%] vs 3828 [34.8%]; HR, 0.90 [95% CI, 0.86-0.94]) and less likely to be hospitalised (HR, 0.90 [95% CI, 0.86-0.94]) within one year of starting SGLT2 inhibitors. There was no difference in all-cause mortality between exposure groups (HR, 0.91 [95% CI, 0.82-1.00]).

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