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Review
. 2024 Sep 19;16(9):e69711.
doi: 10.7759/cureus.69711. eCollection 2024 Sep.

The Comparison of the Effectiveness of Dapagliflozin and Empagliflozin in the Prevention of Cardiovascular Outcomes in Patients With Type 2 Diabetes: A Network Meta-Analysis

Tanya Sinha  1 , Ushna Gul  2 , Nawabzada Nadir Babar  3 , Farhan Israr  4   5 , Aqsa A Butt  6 , Sandipkumar S Chaudhari  7   8 , Hamza Maqbool  9 , Adil Amin  10
Affiliations
Review

The Comparison of the Effectiveness of Dapagliflozin and Empagliflozin in the Prevention of Cardiovascular Outcomes in Patients With Type 2 Diabetes: A Network Meta-Analysis

Tanya Sinha et al. Cureus. .

Abstract

Type 2 diabetes mellitus (T2DM) is a significant risk factor for cardiovascular diseases, prompting research into treatments that can mitigate this risk. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, particularly dapagliflozin and empagliflozin, have shown promising cardiovascular benefits in T2DM patients. This meta-analysis aimed to directly compare the cardiovascular outcomes of these two drugs. To achieve this, we conducted a comprehensive literature search across multiple databases up to August 5, 2024, including both randomized controlled trials (RCTs) and observational studies. The primary outcomes of interest were major adverse cardiovascular events (MACE), atrial fibrillation (AF), cardiovascular mortality, myocardial infarction (MI), and hospitalization for heart failure (HF). Twelve studies met the inclusion criteria for this meta-analysis. The pooled analysis revealed several key findings. Notably, dapagliflozin demonstrated superior efficacy in preventing atrial fibrillation compared to empagliflozin. However, no significant differences were observed between the two drugs in terms of MACE, cardiovascular mortality, hospitalization for heart failure (HHF), or myocardial infarction. When compared to placebo, both dapagliflozin and empagliflozin showed greater effectiveness in preventing adverse cardiovascular outcomes in T2DM patients. These results reinforce the cardiovascular benefits of both dapagliflozin and empagliflozin in patients with T2DM. The comparable efficacy in most outcomes suggests that clinicians have flexibility in prescribing either of these SGLT2 inhibitors. However, the lower risk of atrial fibrillation associated with dapagliflozin may be a crucial factor in treatment decisions, especially for patients with a history of or at high risk for atrial fibrillation.

Keywords: cardiovascular outcomes; dapagliflozin; empagliflozin; systematic review and meta-analysis; type 2 diabetes mellitus.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA flowchart of the study selection process
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 2
Figure 2. Forest plot comparing MACE
References: [15,18,20,22,24] D, dapagliflozin; E, empagliflozin; P, placebo; RR, risk ratio; CI, confidence interval; MACE, major adverse cardiovascular events
Figure 3
Figure 3. Forest plot comparing the risk of atrial fibrillation
References: [14,17,19,23] D, dapagliflozin; E, empagliflozin; P, placebo; RR, risk ratio; CI, confidence interval
Figure 4
Figure 4. Forest plot comparing the risk of cardiovascular mortality
References: [13,15,16,19,20,22,24] D, dapagliflozin; E, empagliflozin; P, placebo; RR, risk ratio; CI, confidence interval
Figure 5
Figure 5. Forest plot comparing the risk of myocardial infarction
References: [15,17,19,20,24] D, dapagliflozin; E, empagliflozin; P, placebo; RR, risk ratio; CI, confidence interval
Figure 6
Figure 6. Forest plot comparing the risk of hospitalization for heart failure
References: [13,15,16,19,20,22,24] D, dapagliflozin; E, empagliflozin; P, placebo; RR, risk ratio; CI, confidence interval
See this image and copyright information in PMC

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