Comparative effectiveness of dapagliflozin vs DPP‐4 inhibitors on a composite endpoint of HbA1c, body weight and blood pressure reduction in the real world. Issue 1 (24th June 2020) - Morieri, Mario Luca
Abstract: Background: Treatment of type 2 diabetes (T2D) should aim at preventing or delaying complications through the control of glycaemia and cardiovascular risk factors. We herein compared the SGLT‐2 inhibitor dapagliflozin vs DPP‐4 inhibitors (DPP‐4i) on a composite endpoint of glycaemic and extraglycaemic effectiveness. Methods: This was a multicentre, retrospective real‐world study conducted at 56 outpatient clinics in Italy. We collected data on patients newly started on dapagliflozin or DPP‐4i in 2015‐2017. The primary endpoint was the proportion of patients attaining a simultaneous reduction of HbA1c ≥0.5%, body weight ≥2 kg, systolic blood pressure (SBP) ≥2 mmHg. Confounding by indication was addressed by propensity score matching (PSM) or multivariable adjustment (MVA). Results: Patients initiating dapagliflozin (n = 2091) or DPP‐4i (n = 2144) differed for most clinical characteristics. After PSM, two well‐balanced groups of 1149 patients each were compared. The primary endpoint was reached in a greater proportion of patients who received dapagliflozin (17.6%) compared to DPP‐4i (11.7%), with a relative risk of 1.50 (1.21‐1.86; P < .001). Similar results were obtained in the as‐treated and intention‐to‐treat datasets or using MVA in place of PSM. The beneficial effect of dapagliflozin was mainly due to its greater effectiveness on body weight and, to a lesser extent, on SBP. The change in HbA1c did not differ between groups. Conclusions: T2D patients initiating the SGLT2i dapagliflozin had a greater probability of attaining a composite endpoint of clinically relevant reductions in HbA1c, body weight and SBP, compared to similar patients initiating a DPP‐4i in the same period and healthcare setting.