ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Gut Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1669613
Comparative effectiveness of empagliflozin versus dapagliflozin in adults with metabolic dysfunction-associated steatotic liver disease
Provisionally accepted
Jheng-Yan Wu1
Yu -Kuan Tu1Chia-Chih Kuo1
Mei-Yuan Liu1
Wan-Hsuan Hsu1
YA-WEN TSAI1
TINGHUI LIU1
Po-Yu Huang1
Min-Hsiang Chuang1
Kuo-Chuan Hung1
Tsung Yu2
Kuang-Ming Liao3*
Chih-Cheng Lai1*- 1Chi Mei Medical Center, Yongkang District, Taiwan
- 2National Cheng Kung University, Tainan City, Taiwan
- 3Chi Mei Medical Center, Chiali, Tainan, Taiwan
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Background: Sodium-glucose co-transporter-2 inhibitors (SGLT2is) show promise in treating metabolic dysfunction-associated steatotic liver disease (MASLD). However, the relative efficacy of different SGLT2is remains unclear. We aimed to compare the clinical effectiveness of empagliflozin versus dapagliflozin in adults with MASLD. Methods: Using the TriNetX database, we conducted a retrospective cohort study of adults with MASLD who were newly prescribed either empagliflozin or dapagliflozin between January 2013 and September 2024. After propensity score matching, we compared 13,274 patients in each group. The primary outcome was a composite of all-cause hospitalization, all-cause mortality, major adverse cardiovascular events (MACEs), major adverse kidney events (MAKEs), and decompensated hepatic events. Secondary outcomes included each individual component of the primary outcome. Results: Empagliflozin was associated with a lower risk of primary composite outcomes compared to dapagliflozin (HR, 0.84; 95% CI, 0.80-0.88). This benefit was consistent across most subgroups, including sex, presence of liver cirrhosis, heart failure, T2DM, and chronic kidney disease. Significant interactions were observed for age groups (p=0.04) and borderline for BMI categories (p=0.06). Empagliflozin also showed lower risks for all-cause hospitalization (HR, 0.84; 95% CI, 0.79-0.88), all-cause mortality (HR, 0.79; 95% CI, 0.66-0.96), MACE (HR, 0.88; 95% CI, 0.78-0.99), and MAKE (HR, 0.63; 95% CI, 0.47-0.86), but no difference in decompensated hepatic events (HR, 1.01; 95% CI, 0.81-1.27). Conclusions: In patients with MASLD, empagliflozin was associated with better clinical outcomes compared to dapagliflozin, particularly in reducing cardiovascular and renal events, hospitalizations, and mortality.
Keywords: empagliflozin, dapagliflozin, Diabetes Mellitus, Metabolic dysfunction-associated steatotic liver disease, Sodium-glucose co-transporter-2 inhibitor
Received: 20 Jul 2025; Accepted: 22 Sep 2025.
Copyright: © 2025 Wu, Tu, Kuo, Liu, Hsu, TSAI, LIU, Huang, Chuang, Hung, Yu, Liao and Lai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Kuang-Ming Liao, abc8870@yahoo.com.tw
Chih-Cheng Lai, dtmed141@gmail.com
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.