Ozempic outperforms another diabetes drug for reducing stroke risk

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Semaglutide more effective at lowering risk for stroke and other cardiovascular outcomes compared to empagliflozin 

Two target trial emulation studies compared mortality and cardiovascular risks in adult patients treated with semaglutide or dulaglutide versus empagliflozin. The study found that semaglutide moderately lowers risk for death, myocardial infarction (MI), and stroke compared to empagliflozin; however, dulaglutide does not have a clinical treatment advantage over empagliflozin. The results are published in Annals of Internal Medicine.

Researchers from the University of Pittsburgh studied data from a retrospective observational cohort of patients 45 years or older with type 2 diabetes, comorbid conditions and a prescription for semaglutide, dulaglutide, or empagliflozin between 1 January 2019 and 31 December 2024. The researchers emulated two target trials of initial treatment with either semaglutide (primary trial) or dulaglutide (secondary trial) versus empagliflozin. The primary outcome was risk for the composite outcome of death, MI, or stroke. Secondary outcomes included all-cause death, MI, stroke, heart failure (HF), and atrial fibrillation. The researchers matched empagliflozin-treated patients to either semaglutide- or dulaglutide-treated patients using propensity score (PS) methods. In the primary trial analysis, 7,899 patients treated with semaglutide were matched to 7,899 patients treated with empagliflozin, with all patients having similar baseline characteristics except a higher body mass index among patients treated with semaglutide. In the secondary trial, 6093 patients treated with dulaglutide were matched with 6,093 patients treated with empagliflozin and baseline characteristics were similar. The researchers found a nominally lower cumulative incidence of death, MI, or stroke in patients using semaglutide versus empagliflozin starting at one-year of follow-up. This was largely driven by a clear lower risk of stroke when using semaglutide versus empagliflozin. All risk estimates favored the use of semaglutide versus empagliflozin for secondary outcomes. In a subgroup analysis, patients younger than 65 years and those with an HbA1C below 7% had a lower risk for death, MI, or stroke when using semaglutide. In the secondary trial, the risk for death, MI, or stroke over follow-up was similar for patients treated with dulaglutide versus empagliflozin.