Dapagliflozin vs empagliflozin in patients with chronic heart failure: a registry analysis

TL;DR

This study compared dapagliflozin and empagliflozin in heart failure patients and found dapagliflozin linked to worse outcomes.

Contribution

Registry analysis comparing real-world efficacy of two SGLT2 inhibitors in chronic heart failure patients.

Findings

Dapagliflozin was associated with higher risk of death or cardiac events compared to empagliflozin.

Patients on dapagliflozin showed worse NYHA functional class at 6 months.

Results suggest a need for a direct randomized trial to confirm these findings.

Abstract

To assess the relative efficacy of dapagliflozin and empagliflozin in routinely treated chronic heart failure (CHF) patients.

Data from a registry of prevalent and incident CHF patients were used to set up cohorts (new-user design) of patients started on dapagliflozin or empagliflozin in addition to other guideline-directed therapy. Cohorts were mutually balanced on a range of characteristics, and were assessed for the incidence of a composite of all-cause death/major adverse cardiac events (primary outcome) over the initial 6 months of treatment, and for New York Heart Association (NYHA) functional class at 6 months (secondary outcome). Frequentist and Bayes estimates were generated for the dapagliflozin vs empagliflozin comparison.

In both prevalent (dapagliflozin n = 393, empagliflozin n = 328) and incident (dapagliflozin n = 124, empagliflozin n = 116) patients, those prescribed dapagliflozin had somewhat higher incidence of the primary outcome, but the confidence intervals were wide (RR = 1.385, 95%CI 0.882-2.173 [prevalent], RR = 2.192, 95%CI 0.765-6.282 [incident]), and were more likely to present with a worse NYHA class at 6 months (OR = 1.552, 95%CI 1.142-2.108 [prevalent], OR = 1.503, 95%CI 0.844-2.676 [incident]). In the pooled data, primary events (n = 102) were more common in dapagliflozin-prescribed patients (frequentist estimate RR = 1.519, 95%CI 1.239-1.861; Bayes RR = 1.380, 95%CrI 0.981-1.944). Dapagliflozin-prescribed patients were also more likely to have a worse NYHA class at 6 months (OR = 1.540, 95%CI 1.208-1.962; Bayes OR = 1.425, 95%CrI 1.098-1.781).

CHF patients prescribed with dapagliflozin had poorer outcomes than their empagliflozin-prescribed peers over the initial 6 months of treatment. Data emphasize a need for a direct randomized comparison of the two treatments in this setting.

Figures