DPP-4 inhibitors and SGLT2 inhibitors are widely used in T2D. Clinical trials demonstrated lower risk of CV events with SGLT2i, and a neutral effect on CV events with DPP-4i. However, large comparative studies are lacking. We compared the risk of death, hospitalization for heart failure (HHF), MI and stroke in patients starting the SGLT2i dapagliflozin (DAPA) vs. any DPP-4i, using real world data from S. Korea, Japan, Israel, and Canada. Patients initiating DAPA or DPP-4i were identified via national registries, claims, and medical records. Propensity scores for SGLT2i initiation were developed in each country, with 1:1 matching. Hazard ratios were assessed by country and pooled using weighted meta-analysis, with an intent-to-treat approach. In total, 128,066 patients were included (mean age 55 years, 46% women, 25% with history of CVD). Post-match, baseline characteristics were balanced across matched groups. Initiation of DAPA vs. DPP-4i was associated with significantly lower risk of death, HHF, MI and stroke (Figure 1). In a large cohort of T2D patients seen in clinical practice across 4 countries, 75% without established CVD, initiation of DAPA was associated with lower risk of CV events (including stroke) and death compared with DPP-4i.


S. Kohsaka: Research Support; Self; Bayer Yakuhin, Ltd.. Speaker's Bureau; Self; Bayer Yakuhin, Ltd.. Research Support; Self; Daiichi Sankyo Company, Limited. Speaker's Bureau; Self; Bristol-Myers Squibb Company. C.S. Lam: Research Support; Self; Boston Scientific Corporation, Bayer AG, Thermofisher, Medtronic, Vifor Pharma. Consultant; Self; Bayer AG, Novartis AG, AstraZeneca, Janssen Research & Development, Menarini Group, Abbott, Roche Diagnostics Corporation, Boehringer Ingelheim GmbH, Merck & Co., Inc.. D. Kim: None. A. Karasik: Stock/Shareholder; Self; Novo Nordisk A/S. Research Support; Self; Novo Nordisk A/S. Advisory Panel; Self; Novo Nordisk A/S, AstraZeneca. Research Support; Self; AstraZeneca. Consultant; Self; Boehringer Ingelheim GmbH. Advisory Panel; Self; Merck & Co., Inc., GlucoMe. N. Tangri: Research Support; Self; AstraZeneca. Advisory Panel; Self; AstraZeneca, Otsuka Holdings Co., Ltd. S. Goh: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim GmbH, Amgen Inc., Novo Nordisk A/S, Sanofi-Aventis, Servier. M. Thuresson: Consultant; Self; AstraZeneca. H. Chen: Employee; Self; AstraZeneca. F. Surmont: Employee; Self; AstraZeneca. N. Hammar: Employee; Self; AstraZeneca. Stock/Shareholder; Self; AstraZeneca. P. Fenici: Employee; Self; AstraZeneca. M. Kosiborod: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Amgen Inc., Sanofi, Boehringer Ingelheim GmbH, GlaxoSmithKline plc., Glytec Systems, Merck & Co., Inc., Novo Nordisk A/S, Janssen Pharmaceuticals, Inc., ZS Pharma, Inc., Intarcia Therapeutics, Inc., Novartis AG. Research Support; Self; AstraZeneca, Boehringer Ingelheim GmbH.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.