Dapagliflozin vs. empagliflozin in patients with chronic heart failure:
a single-center registry analysis
Abstract
Purpose. To assess relative efficacy of dapagliflozin and empagliflozin
in routinely treated chronic heart failure (CHF) patients. Methods. In
this single-center registry analysis, prevalent and incident CHF
patients with a wide range of left ventricular ejection fraction values
started on dapagliflozin or empagliflozin in addition to other
guideline-directed therapy were mutually balanced on a range of
characteristics, and were assessed for incidence of a composite of
all-cause death/major adverse cardiac events (primary outcome) over the
initial 6 months of treatment, and for New Your Heart Association (NYHA)
functional class at 6 months (secondary outcome). Frequentist and Bayes
(with a moderately informed skeptical prior) estimates were generated
for dapagliflozin vs. empagliflozin comparison. Results. 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 and
were more likely to present with a worse NYHA class at 6 months, but the
estimates were imprecise. In the pooled data, primary events (102 in
total) 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 were
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). Conclusion. CHF
patients prescribed with dapagliflozin apparently had poorer outcomes
than those prescribed with empagliflozin over the initial 6 months of
treatment. Data emphasize a need for a direct randomized comparison of
the two treatments in this setting.