SGLT2 Inhibitor Alternatives for Type 2 Diabetes

Introduction to SGLT2 Inhibitors

Dapagliflozin, canagliflozin, and ertugliflozin are comparable alternatives to Jardiance (empagliflozin) due to their similar efficacy, safety profiles, and cardiovascular benefits as SGLT2 inhibitors 1, 2

The American Diabetes Association recommends dapagliflozin (Farxiga) as a highly selective SGLT2 inhibitor with demonstrated cardiovascular benefits, particularly in reducing heart failure hospitalization risk 3
Canagliflozin (Invokana) is an SGLT2 inhibitor with proven cardiovascular and renal benefits in patients with type 2 diabetes and high cardiovascular risk, as recommended by the American College of Cardiology 1, 4
Ertugliflozin is a more recent SGLT2 inhibitor with similar glycemic efficacy, though with less robust cardiovascular outcomes data compared to empagliflozin, according to the European Association for the Study of Diabetes 1, 2

All SGLT2 inhibitors provide similar glycemic control, typically reducing HbA1c by approximately 0.7-1.0% when added to metformin, as stated by the American Association of Clinical Endocrinologists 1
SGLT2 inhibitors offer additional benefits beyond glycemic control, including cardiovascular risk reduction, particularly for heart failure hospitalization, as recommended by the American Heart Association 5, 3
SGLT2 inhibitors have renoprotective effects, especially in patients with albuminuria, according to the National Kidney Foundation 6, 4

Empagliflozin (Jardiance) demonstrated a 38% reduction in cardiovascular death and 35% reduction in heart failure hospitalization in the EMPA-REG OUTCOME trial, as reported by the American College of Cardiology 7
Dapagliflozin (Farxiga) showed a 27% reduction in heart failure hospitalization in DECLARE-TIMI 58 and significant benefits in the DAPA-HF trial for patients with heart failure, according to the European Society of Cardiology 3, 8
Canagliflozin (Invokana) provided a 33% reduction in heart failure hospitalization in CANVAS and 39% reduction in CREDENCE trial, as stated by the American Diabetes Association 7, 4

The median monthly costs (AWP) for maximum approved daily doses are similar across the class, with canagliflozin (300 mg) costing $622 1
Ertugliflozin (15 mg) offers a potentially more cost-effective option, with a cost of $354, as reported by the American College of Clinical Pharmacy 1

For patients with established atherosclerotic cardiovascular disease (ASCVD), empagliflozin or canagliflozin are preferred based on strongest outcome data, as recommended by the American College of Cardiology 5, 4
For patients with heart failure (regardless of ejection fraction), dapagliflozin or empagliflozin are preferred based on dedicated heart failure trials, according to the American Heart Association 3, 8
For patients with diabetic kidney disease, canagliflozin has the strongest dedicated renal outcomes data (CREDENCE trial), as stated by the National Kidney Foundation 4
For patients with cost concerns, ertugliflozin offers the lowest cost option with similar glycemic efficacy, as reported by the American Diabetes Association 1

The American College of Cardiology recommends both empagliflozin and dapagliflozin for heart failure patients regardless of diabetes status, with dapagliflozin reducing the composite of cardiovascular death or heart failure hospitalization by approximately 25% in the DAPA-HF trial 9
Empagliflozin showed a 21% reduction in the composite of cardiovascular death or hospitalization for worsening heart failure in EMPEROR-Reduced, and is effective in heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) 10, 11

The American Diabetes Association suggests that the benefits of both medications appear to be a class effect and are largely independent of glycemic control, according to Diabetes Care 11