Comparative Effectiveness and Prescribing Patterns of Dapagliflozin Vs Empagliflozin in Type 2 Diabetes Patients: a Target Trial Emulation.

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.