Relative Efficacy and Safety of Canagliflozin, Dapagliflozin, Empagliflozin, and Sotagliflozin in Patients With Type 2 Diabetes at Risk of or With Established Cardiovascular Disease: A Network Meta‐Analysis
Abstract
This study aims to evaluate the relative efficacy and safety of sodium‐glucose cotransporter 2 (SGLT2) inhibitors in patients with Type 2 diabetes mellitus (T2DM) and established cardiovascular disease (CVD) or at risk for CVD. Primary efficacy outcomes were cardiovascular (CV) death and hospitalization for heart failure (HFH); primary safety outcomes were major hypoglycemic events and genital mycotic infections.
We performed a targeted literature search on PubMed through December 2023 to identify randomized controlled trials (RCTs) assessing the efficacy and safety of sotagliflozin, empagliflozin, canagliflozin, and dapagliflozin in patients with T2DM and established CVD or at risk for CVD. Subsequently, we used a random‐effects network meta‐analysis for an indirect treatment comparison of 4 relevant RCTs, to estimate the relative hazard ratio ([HR], for efficacy outcomes), odds ratio ([OR], for safety outcomes), and 95% confidence interval (CI).
This study showed key differences in the efficacy and safety among SGLT2 inhibitors. Dapagliflozin (HR, 1.58; 95% CI, 1.19–2.11) and canagliflozin (HR, 1.40; 95% CI, 1.04–1.89) were associated with a higher rate of CV death compared to empagliflozin. Dapagliflozin and empagliflozin decreased the odds of major hypoglycemic events when compared to sotagliflozin (OR, 0.15; 95% CI, 0.03–0.72) and (OR, 0.21; 95% CI, 0.04–0.95), respectively. Canagliflozin increased the odds of major hypoglycemic events when compared to dapagliflozin…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
Read the paper
Related studies
- Strategy for Mitigating DKA Risk in Patients with Type 1 Diabetes on Adjunctive Treatment with SGLT Inhibitors: A STICH Protocol
- Glucoraphanin: a broccoli sprout extract that ameliorates obesity-induced inflammation and insulin resistance
- SGLT2 Inhibitors in Heart Failure: Targeted Metabolomics and Energetic Metabolism
- Mechanisms of blood pressure reduction with sodium-glucose co-transporter 2 (SGLT2) inhibitors
- Sodium-glucose cotransporter inhibitors: beyond glycaemic control
- Decoding the effects of SGLT2 inhibitors on cardiac arrhythmias in heart failure
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.