Comparative Cardiovascular Effectiveness of Empagliflozin Versus Dapagliflozin in Adults With Treated Type 2 Diabetes: A Target Trial Emulation
An erratum to this article was published (Circulation, 21 Jan 2025 ↗)
Authors' conclusion
Empagliflozin and dapagliflozin initiators had no differences in 6-year cardiovascular outcomes in adults with treated type 2 diabetes with or without coexisting atherosclerotic cardiovascular disease or HF.
Study context
- Population
- Adults with treated T2DM, Denmark, 2014–2020
- Participants
- 36,670 vs 20,606
- Exposure
- Empagliflozin vs dapagliflozin initiation, in addition to standard care
- Empagliflozinn = 36,670
- Dapagliflozinn = 20,606reference
- Outcome
- MACE:
- MI
- Ischemic stroke
- HF
- CV death
- Follow-up
- 6 years
Methodological detailsregistry-based cohort study, nationwide, population-based Danish registries, inverse probability of treatment and censoring weights, 57 potential confounders
- Registry-based cohort study
- Nationwide, population-based Danish registries
- Inverse probability of treatment and censoring weights
- 57 potential confounders
Main finding
As reported in the abstract
MACE
Each group vs dapagliflozinRisk difference (95% CI)
Empagliflozin
0.0%(−0.9% to 1.0%)
Each group vs dapagliflozinRisk ratio (95% CI)
Empagliflozin
1.00(0.91–1.11)
Observational data: associations, not effects.
Further findings
MACE by coexisting ASCVD and heart failure (HF) (subgroups, ITT) · 6 years
- With ASCVD: risk difference
- −2.3% [95% CI, −8.2% to 3.5%]
- With ASCVD: risk ratio
- 0.92 [95% CI, 0.74 to 1.14]
- Without ASCVD: risk difference
- 0.3% [95% CI, −0.6% to 1.2%]
- Without ASCVD: risk ratio
- 1.04 [95% CI, 0.93 to 1.16]
- With HF: risk difference
- 1.1% [95% CI, −6.5% to 8.6%]
- With HF: risk ratio
- 1.04 [95% CI, 0.79 to 1.37]
- Without HF: risk difference
- −0.1% [95% CI, −1.0% to 0.8%]
- Without HF: risk ratio
- 0.99 [95% CI, 0.90 to 1.09]
- Findings consistent with the overall result
- Intention-to-treat
MACE, per-protocol analysis (secondary analysis) · 6 years
- 6-year risk
- 9.1% versus 8.8%
- Risk difference
- 0.2% [95% CI, −2.1% to 2.5%]
- Risk ratio
- 1.03 [95% CI, 0.80 to 1.32]
- Per-protocol
- Not different
Original publication
Comparative Cardiovascular Effectiveness of Empagliflozin Versus Dapagliflozin in Adults With Treated Type 2 Diabetes: A Target Trial Emulation. Circulation. Published 29 August 2024. doi:10.
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