Forxiga (dapagliflozin) and Jardiance (empagliflozin), the two representative SGLT-2 inhibitors, are competing not only in diabetes but cardio and renal diseases.
On Thursday, AstraZeneca said Forxiga met the primary endpoint in a large-scale global phase 3 study, DELIVER, reducing the risk of cardiovascular death and worsening heart failure (HF) in patients with heart failure with preserved ejection fraction (HFpEF).
Earlier, Forxiga proved the effect of reducing the risk of cardiovascular death and worsening HF in phase 3 DAPA-HF trial on patients with heart failure with reduced ejection fraction (HFrEF).
The latest data from DELIVER solidified Forxiga’s therapeutic effect on treating HF, regardless of ejection fraction.
The latest data made Forxiga compete against Jardiance, which proved its effectiveness in HFpEF patients earlier.
SGLT-2 inhibitors were initially developed as type-2 diabetes treatment, and they also proved effective in protecting the heart and the kidney, becoming the most attention-drawing treatment in chronic diseases.
The versatile benefits of SGLT-2 inhibitors were revealed after the FDA made cardiovascular outcome trials (CVOT) mandatory to prove the cardiovascular safety of new diabetes drugs in 2008.
Among SGLT-2 inhibitors, Jardiance was the first to prove cardiovascular benefit.
In the EMPA-REG OUTCOME study, Jardiance was the first SGLT-2 inhibitor to demonstrate cardiovascular benefit compared with a placebo.
Forxiga proved cardiovascular safety in DECLARE-TIMI 58, a CVOT, but failed to reach statistical significance in cardiovascular benefit.
However, Forxiga’s effect on reducing hospitalization for HF in the study broadened the SGLT-2 inhibitor’s role in treating HF.
Later in the DAPA-HF study, Forxiga became the first SGLT-2 inhibitor to show efficacy in treating HF and confirmed the SGLT-2 inhibitor’s value as a drug for heart disease.
Also, Forxiga confirmed its renal protection effect in DAPA-CKD patients with chronic renal diseases, which was consistently shown in DECLARE-TIMI 58 and DAPA-HF studies.
Even though Jardiance is no longer the first SGLT-2 inhibitor to treat HF and renal diseases, it proved efficacy in treating HFrEF in the EMPEROR-Reduced trial and chronic renal disease in the EMPA-KIDNEY study.
In addition, Jardiance proved a benefit in HFpEF patients, taking up more than half of HF patients, in EMPEROR-Preserved, before Forxiga, and became the first HF treatment to win approval, regardless of ejection fraction, both in the U.S. and Europe.
Forxiga and Jardiance have raced to prove effectiveness in various diseases for the first time, leading the SGLT-2 inhibitor market.
Drugs in the same class include Janssen’s Invokana (canagliflozin), MSD’s Steglatro (ertugliflozin), and Astellas Pharma’s Suglat (ipragliflozin). However, these drugs can treat type-2 diabetes only.
Local and international treatment guidelines mention Forxiga and Jardiance as the only SGLT-2 inhibitors to treat HF because they secured clinical evidence.
In global sales, Jardiance is a step ahead of Forxiga. Jardiance sold approximately $4.3 billion globally last year, and Forxiga, about $3 billion.