Empagliflozin versus dapagliflozin in patients with liver cirrhosis: A comparative real-world study on hepatic decompensation
Abstract
Background and aim: Sodium-glucose cotransporter-2 inhibitors may improve outcomes in liver cirrhosis, but comparative evidence between individual agents is limited. We compared real-world outcomes of empagliflozin versus dapagliflozin in adults with liver cirrhosis.
Materials and methods: We conducted a multicenter retrospective cohort study using the TriNetX US Collaborative Network (69 healthcare organizations). Adults with cirrhosis who were newly prescribed empagliflozin or dapagliflozin after the diagnosis of cirrhosis between March 1, 2013 and January 1, 2025, were included. Propensity score matching (1:1) was used to balance baseline characteristics. Outcomes were assessed from day 1 after the index prescription through 5 years. Primary outcomes were all-cause mortality and all-cause hospitalization. Secondary outcomes included hepatic decompensation events. Tertiary outcomes included prognostic hepatic and renal biomarkers. Safety outcomes included the incidence of acute kidney injury, urinary tract infection, and diabetic ketoacidosis.
Results: Before matching, 17,700 empagliflozin users and 8,619 dapagliflozin users were identified; 7,852 patients remained in each cohort after matching. Five-year mortality was similar between groups (12.7% vs. 12.6%; odds ratio [OR]: 1.012, 95% confidence interval [CI]: 0.921-1.112; p=0.8075), as was the risk of hospitalization (14.7% vs. 13.4%; OR: 1.105, 95% CI: 0.94-1.30; p=0.216). Empagliflozin was associated with lower rates…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 7,852 participants or records.
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