JAMA Intern Med
Comparing efficacy and safety outcomes of SGLT-2 inhibitors: How do they stack up?
Although the CV effectiveness of canagliflozin, dapagliflozin, and empagliflozin is similar, clinicians should consider the differential safety profiles when prescribing these medications. Specifically, the increased risk of heart failure hospitalization with low-dose dapagliflozin and the higher risk of severe UTIs with canagliflozin should be taken into account.
Study details: This comparative effectiveness study utilized target trial emulation with data from three U.S. claims databases, including 657,814 adults with T2DM who initiated canagliflozin, dapagliflozin, or empagliflozin between August 2014 and June 2020.
Results: Canagliflozin and dapagliflozin had comparable risks to empagliflozin for MI or stroke (HR, 0.98 and 0.95, respectively). However, dapagliflozin was associated with a higher risk of heart failure hospitalization (HR, 1.19), particularly at the low dose of 5 mg (HR, 1.30). Safety profiles varied, with canagliflozin showing a higher risk of severe UTIs (HR, 1.13) and a lower risk of genital infections (HR, 0.94), while dapagliflozin had lower risks of genital infections (HR, 0.92) and diabetic ketoacidosis (DKA) (HR, 0.78) compared with empagliflozin.
Source:
Shin H, et al. (2025, January 21). JAMA Intern Med. Comparative Effectiveness of Individual Sodium-Glucose Cotransporter 2 Inhibitors. https://pubmed.ncbi.nlm.nih.gov/39836397/