Abstract 12476: Dapagliflozin versus Empagliflozin and the Risk for Cardiovascular Outcomes in Patients With Type 2 Diabetes: A Nationwide Population-Based Study

Introduction: Dapagliflozin and empagliflozin are the two most widely used sodium-glucose co-transporter 2 inhibitors (SGLT2i) for type 2 diabetes (T2DM) worldwide. The study was conducted to compare the cardiovascular outcomes of two SGLT2i, dapagliflozin and empagliflozin. Methods: We conducted a nationwide cohort study using the Korean National Health Insurance Service database and an active-comparator new-user design. Patients newly prescribed either dapagliflozin or empagliflozin between 2016 and 2018 for T2DM were retrospectively analyzed and matched in a 1:1 ratio based on propensity scores estimated using 53 potential confounding variables. The primary outcome was major adverse cardiovascular events (MACE), which is a composite of myocardial infarction, ischemic stroke, heart failure (HF) events (i.e., hospitalization for HF or HF-related death), and cardiovascular death. Secondary outcomes were HF events, cardiovascular death, and all-cause mortality. Results: A total of 145,502 patients were included in the final analysis (mean age 57±12 years, 57% male). During mean follow-up of 2.1±0.7 years, there was no significant difference in the incidence of MACE between the two groups (incidence rate 6.95 vs. 7.33 per 1000 person-years). The hazard ratio [HR] for dapagliflozin to empagliflozin users was 0.95 (95% confidence interval [CI] 0.87-1.03; P= 0.199). Regarding secondary outcomes, however, compared with empagliflozin users, dapagliflozin users had a lower risk of HF events (HR 0.84, 95% CI 0.71-0.98; P= 0.032), and cardiovascular death (HR 0.82, 95% CI 0.68-1.00; P= 0.047), other than all-cause mortality (HR 1.00, 95% CI 0.92-1.09; P= 0.934). Conclusions: In this large nationwide cohort study, the risk of MACE was similar between dapagliflozin and empagliflozin users. Yet, dapagliflozin users, as compared with empagliflozin users, were associated with a reduced risk of hospitalization for HF or HF-related death and cardiovascular death.