Comparative Effects of Empagliflozin and Dapagliflozin in Stable Chronic Heart Failure ― A Prospective Crossover Study ―

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Background: Empagliflozin and dapagliflozin are both approved for the treatment of chronic heart failure (CHF), but their comparative efficacy remains uncertain. Therefore, we aimed to prospectively compare the effects of 10 mg empagliflozin and 10 mg dapagliflozin on NT-proBNP levels and clinical outcomes in patients with stable CHF. Methods and Results: In this single-center, open-label, prospective crossover study, 25 patients with stable CHF (age 74.3±11.9 years; 68% male) were enrolled. Patients were initially treated with either empagliflozin (n=6) or dapagliflozin (n=19) for ≥3 months before switching to the alternative agent. Follow-up assessments were conducted 1 month after the switch. Patients then selected their preferred agent and were followed for ≥1year. NT-proBNP levels were significantly higher in patients initially treated with empagliflozin compared to those treated with dapagliflozin (3,334±2,107 vs. 1,101±923 pg/mL, P=0.001). However, NT-proBNP levels did not change significantly in either group following the crossover. During follow-up, 6 patients (24%) were hospitalized for worsening HF, with no significant difference between treatment groups. Notably, NT-proBNP ≥1,453 pg/mL was significantly associated with poorer outcomes (P=0.008). Conclusions: In this crossover study, empagliflozin and dapagliflozin showed comparable effects on NT-proBNP levels and clinical outcomes, supporting their interchangeable use in stable CHF.

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