Key result
Indirect comparisons of SGLT2 inhibitors in heart failure showed no significant differences in cardiovascular death or heart failure hospitalization (e.g., dapagliflozin vs empagliflozin OR 1.00; 95% CI 0.66-1.55).
Why the study?
Head-to-head comparisons among SGLT2 inhibitor treatments in established heart failure remain absent.
Does the choice of specific SGLT2 inhibitor (dapagliflozin, empagliflozin, or sotagliflozin) improve cardiovascular outcomes differently in patients with established heart failure?
Meta-Analysis
Does the choice of specific SGLT2 inhibitor (dapagliflozin, empagliflozin, or sotagliflozin) improve cardiovascular outcomes differently in patients with established heart failure?
A network meta-analysis suggests a class effect for SGLT2 inhibitors in heart failure, with no significant differences in major efficacy outcomes between dapagliflozin, empagliflozin, and sotagliflozin.
Similar efficacy across SGLT2 inhibitors supports interchangeable use in heart failure; leaves open need for direct head-to-head trials.
AIMS: Head-to-head comparisons among SGLT2 inhibitors treatments in established heart failure remain absent. We conducted a systematic review of dedicated heart failure trials to assess indirectly the composite outcomes and individual clinical endpoints among SGLT2 inhibitor treatments. METHODS AND RESULTS: We systematically reviewed randomized controlled trials comparing SGLT2 inhibitors versus placebo in patients with established heart failure. A Bayesian approach to network meta-analysis was applied. Five trials including four treatment strategies were included in this study. The composite of cardiovascular death or hospitalization for heart failure showed no significant difference in the comparison between dapagliflozin and empagliflozin (OR 1.00, 95% CI 0.66-1.55), dapagliflozin and sotagliflozin (OR 1.54, 95% CI 0.91-2.65), and empagliflozin and sotagliflozin (OR 1.53, 95% CI 0.90-2.69). All-cause mortality showed no significant difference in the comparison between dapagliflozin and empagliflozin (OR 0.92, 95% CI 0.711-1.18), dapagliflozin and sotagliflozin (OR 1.05, 95% CI 0.68-1.59), and empagliflozin and sotagliflozin (OR 1.14, 95% CI 0.74-1.73). Cardiovascular death showed no significant difference in the comparison between dapagliflozin and empagliflozin (OR 0.94, 95% CI 0.71-1.23), dapagliflozin and sotagliflozin (OR 0.96, 95% CI 0.61-1.55), and empagliflozin and sotagliflozin (OR 1.03, 95% CI 0.64-1.66). Hospitalization for heart failure showed no significant difference in the comparison between dapagliflozin and empagliflozin (OR 1.13, 95% CI 0.64-1.97), dapagliflozin and sotagliflozin (OR 1.56, 95% CI 0.74-3.15), and empagliflozin and sotagliflozin (OR 1.39, 95% CI 0.68-2.78). CONCLUSIONS: In patients with established heart failure, there was no significant difference of the major efficacy outcomes among SGLT2 inhibitor treatments; however, sotagliflozin may be associated with the lowest risk of the composite of cardiovascular death or hospitalization for heart failure, and dapagliflozin may be associated with the lowest risk of all-cause and cardiovascular mortality.
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Chen et al. (2023) conducted a meta-analysis in established heart failure. SGLT2 inhibitors (dapagliflozin, empagliflozin, sotagliflozin) vs. SGLT2 inhibitors (indirect comparison) was evaluated on Composite of cardiovascular death or hospitalization for heart failure (OR 1.00, 95% CI 0.66-1.55). Indirect comparisons of SGLT2 inhibitors in heart failure showed no significant differences in cardiovascular death or heart failure hospitalization (e.g., dapagliflozin vs empagliflozin OR 1.00; 95% CI 0.66-1.55).
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