medwireNews: There is no significant difference in kidney outcomes between people with type 2 diabetes who initiate treatment with empagliflozin and those who start dapagliflozin, shows a target trial emulation using Danish nationwide data.
Kasper Bonnesen (Aarhus University, Copenhagen, Denmark) and co-investigators say that their results “support the current clinical practice of not recommending either drug [versus] the other when used for treating type 2 diabetes.”
The study included routinely collected Danish healthcare data for 50,283 adults (median age 63 years, 37.5% women) with type 2 diabetes who received antihyperglycemic treatment between 2014 and 2020. They had a median diabetes duration of 8 years and a median estimated glomerular filtration rate (eGFR) of 88 mL/min per 1.73 m2.
Bonnesen et al report in JAMA Internal Medicine that, after adjustment for potential confounders, the 6-year cumulative incidence of acute kidney injury (creatinine increase of ≥26.5 μmol/L or ≥1.5 times baseline within 48 hours) was 18.2% among the 32,819 individuals who initiated treatment with empagliflozin and 18.5% among the 17,464 given dapagliflozin.
The difference between the two sodium-glucose cotransporter (SGLT)2 inhibitors was not statistically significant and there was also no significant difference in the rate of diagnosis of stages G3 to G5 chronic kidney disease (CKD) in people with an eGFR of at least 60 mL/min per 1.73 m2 or higher at baseline, at 11.8% with empagliflozin and 12.1% with dapagliflozin.
Similarly, there were no significant differences between empagliflozin and dapagliflozin treatment in the likelihood of stage A2 or A3 CKD in people without albuminuria at baseline (14.8 vs 14.3%) or for progression of CKD (≥40% decrease in eGFR from baseline) in those with a baseline eGFR below 60 mL/min per 1.73 m2 (5.3 vs 5.7%).
Bonnesen and co-authors say: “In the absence of a large, randomized clinical trial directly comparing kidney outcomes between empagliflozin and dapagliflozin, this emulation of such a target trial provides what is to our knowledge the best currently available evidence for guiding clinical decision-making.”
They add: “Although the findings indicate a class effect of [SGLT2 inhibitors], this cannot be confirmed before comparing the remaining [SGLT2 inhibitors].”
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