Semaglutide Offers Cardiovascular Edge Over Empagliflozin in Type 2 Diabetes
FRIDAY, June 20, 2025 -- For patients aged 45 years or older with type 2 diabetes, semaglutide seems to confer some advantage over empagliflozin in terms of mortality and cardiovascular event risks, according to a study published online June 17 in the Annals of Internal Medicine.
Anum Saeed, M.D., from the University of Pittsburgh, and colleagues compared mortality and cardiovascular event risks in patients treated with semaglutide versus empagliflozin and dulaglutide versus empagliflozin in target trial emulation studies. Patients aged 45 years or older with type 2 diabetes treated from Jan. 1, 2019, to Dec. 31, 2024, with semaglutide, dulaglutide, or empagliflozin were included in the study.
The researchers found that the rates of the composite of death, myocardial infarction (MI), or stroke were 3.7 and 4.5 percent at two years for patients treated with semaglutide and empagliflozin (7,899 and 7,899 patients), respectively, and 5.9 versus 6.9 percent at three years. For the composite outcome, the corresponding incidence rates were 20.99 versus 23.56 per 1,000 person-years, with a hazard ratio of 0.98 (95 percent confidence interval, 0.78 to 1.02). For the individual outcomes of death, MI, and stroke, the hazard ratios (95 percent confidence intervals) were 0.97 (0.81 to 1.15), 0.85 (0.68 to 1.05), and 0.62 (0.43 to 0.89), respectively. For the composite outcome and for death, MI, and stroke separately, the risks for dulaglutide- and empagliflozin-treated patients were similar.
"The apparent modest treatment benefit of semaglutide over empagliflozin coincided with modest greater reductions in weight and HbA1c within the first year of use," the authors write.
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