(A-132) Comparative Effectiveness of Empagliflozin and Dapagliflozin in Patients with Heart Failure Without Diabetes: A Real-World Analysis

Background: Sodium-glucose co-transporter 2 inhibitors, including dapagliflozin and empagliflozin, were initially approved for the treatment of type-2 diabetes and later received Food and Drug Administration approval for heart failure (HF) because of their cardiovascular benefits, independent of glycemic control. While clinical trials have shown their efficacy in HF patients regardless of diabetes status, real-world evidence, particularly in patients without diabetes, remains limited. Although cohort studies suggest empagliflozin may reduce hospitalization more than dapagliflozin, a direct head-to-head comparison in the US population without diabetes is lacking.

Objectives: To evaluate the real-world comparative effectiveness of empagliflozin versus dapagliflozin in preventing HF and all-cause hospitalizations among patients with HF but without diabetes.

Methods: We conducted a new-user, active-comparator cohort study using the MarketScan® Commercial and Medicare Supplemental databases (2012–2023) to evaluate patients with HF but without diabetes who initiated empagliflozin or dapagliflozin. The index date was defined as the first prescription fill for either medication. Patients were required to have continuous healthcare plan enrollment for at least six months before the index date (baseline period). We excluded patients who had a diabetes diagnosis or had used any antidiabetic medications during the baseline period. To ensure comparability between groups, we performed 1:1 propensity score matching based on demographics, selected comorbidities, medication use, and healthcare visits. Cox proportional hazards regression models were then used to compare the risk of HF and all-cause hospitalizations between empagliflozin and dapagliflozin users.

Results: After PS matching, 7,342 patients (3,671 empagliflozin users and 3,671 dapagliflozin users) were included. The incidence of HF hospitalization was 1.15 per 100 person-months for empagliflozin users and 1.02 per 100 person-months for dapagliflozin users. There was no significant difference in risk of HF-related hospitalization (adjusted hazard ratio [aHR], 1.05; 95% confidence interval [CI], 0.90-1.22) and all-cause hospitalization (aHR, 1.05; 95% CI, 0.95-1.17) between empagliflozin and dapagliflozin groups.

Conclusions: Among commercially insured patients with HF but without diabetes, there was no significant difference in the risk of HF-related or all-cause hospitalization between those treated with empagliflozin and those treated with dapagliflozin.