Comparative effectiveness and prescribing patterns of dapagliflozin vs empagliflozin in type 2 diabetes patients: a target trial emulation

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice Pub Date : 2025-08-22 DOI:10.1016/j.diabres.2025.112427

I-Ning Yang , Kah-Suan Chong , Zi-Yang Peng , Huang-Tz Ou , Ming-Cheng Wang

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引用次数: 0

Abstract

Aims

This study aimed to compare the real-world effectiveness of dapagliflozin versus empagliflozin in patients with type 2 diabetes (T2D) and to examine prescribing patterns across specialties.

Methods

We conducted a target trial emulation using multi-institutional electronic health records from January 2016 to August 2023, identifying 2649 new users of dapagliflozin and 2046 of empagliflozin. The primary composite outcome was sustained eGFR decline ≥30 %, end-stage renal disease, heart failure hospitalization, or all-cause mortality. Safety outcomes included acute kidney injury, hypoglycemia, urinary tract infection, and fracture. Inverse probability of treatment weighting (IPTW) was used for confounding adjustment, and Cox regression estimated hazard ratios.

Results

After IPTW, 1662 patients remained in each group. No significant differences were found in primary, secondary, or safety outcomes. However, analysis among patients without stable prior ACEI/ARB exposure revealed a higher risk of all-cause mortality with empagliflozin. Dapagliflozin was more often prescribed by cardiologists, while endocrinologists and nephrologists favored empagliflozin.

Conclusions

Dapagliflozin and empagliflozin showed similar cardiorenal and safety outcomes in T2D. However, unstable prior ACEI/ARB use may influence mortality risk with empagliflozin. Prescribing patterns highlight the importance of multidisciplinary care. Further prospective studies are needed.

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达格列净与恩格列净在2型糖尿病患者中的比较疗效和处方模式：一项目标试验模拟

目的：本研究旨在比较达格列净与恩格列净在2型糖尿病（T2D）患者中的实际疗效，并检查各专科的处方模式。方法利用2016年1月至2023年8月的多机构电子健康记录，对2649名达格列净新使用者和2046名恩帕格列净新使用者进行目标模拟试验。主要综合结局为eGFR持续下降≥30%、终末期肾病、心力衰竭住院或全因死亡率。安全性结果包括急性肾损伤、低血糖、尿路感染和骨折。使用处理加权逆概率（IPTW）进行混杂校正，并用Cox回归估计风险比。结果IPTW结束后，两组各保留1662例患者。在主要、次要或安全性结果方面没有发现显著差异。然而，对先前没有稳定ACEI/ARB暴露的患者的分析显示，恩格列净的全因死亡率更高。心脏病专家更常开达格列净，而内分泌学家和肾病学家更喜欢恩帕格列净。结论斯帕格列净和恩帕格列净在T2D中具有相似的心肾和安全性结果。然而，先前不稳定的ACEI/ARB使用可能会影响恩格列净的死亡风险。处方模式突出了多学科治疗的重要性。需要进一步的前瞻性研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.