김수연 (성균관대학교 약학대학) | 한빛사논문 > 한빛사

한빛사논문

조회91

성균관대학교 약학대학

Diabetologia, Sep 30 2026, | https://doi.org/10.1007/s00125-026-06870-8 Comparative hepatic effectiveness of empagliflozin vs dapagliflozin among individuals with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease

Suyeon Kim ¹, Hwa Yeon Ko ^{1 2}, Bin Hong^{1 3 4}, Ju Hwan Kim ^{1 3}, Sungho Bea ⁵, Jae Hyun Bae^{6 7}, Young Min Cho^{6 7}, Yoosoo Chang ^{8 9 10}, Christopher D Byrne ^{11 12}, Ju-Young Shin¹³

¹School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.
²Department of Medicine, CHA University School of Medicine, Seongnam, South Korea.
³Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea.
⁴Gerald Bronfman Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
⁵Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁶Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
⁷Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
⁸Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine, Seoul, South Korea.
⁹Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine, Seoul, South Korea.
¹⁰Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea.
¹¹Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK.
¹²National Institute for Health and Care Research, Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK.
¹³College of Pharmacy, Seoul National University, Seoul, South Korea.

Suyeon Kim and Hwa Yeon Ko contributed equally as co-first authors.
Corresponding author: Ju-Young Shin

Abstract

While both empagliflozin and dapagliflozin are known to improve hepatic steatosis and liver enzyme levels, robust phase 3 trial evidence for improving steatohepatitis and fibrosis is currently exclusive to dapagliflozin. Therefore, a head-to-head comparison between two agents is warranted, to compare the hepatic outcomes between empagliflozin and dapagliflozin in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD). Using nationwide Korean claims data, we constructed a new-user cohort of adults with MASLD, defined as having type 2 diabetes and a fatty liver index (FLI) ≥60, who initiated empagliflozin or dapagliflozin between May 2016 and December 2023. Outcomes of interest were FLI-defined MASLD regression (achieving FLI <30) and decompensated hepatic events (ascites, variceal bleeding, hepatic failure, liver transplantation). After 1:1 propensity score matching, HRs and 95% CIs were estimated using Cox models. Among 265,098 new users of empagliflozin and dapagliflozin, 101,487 pairs were 1:1 propensity score-matched (mean age 54.3 years; male 71.3%). Compared with dapagliflozin, empagliflozin was associated with a marginally higher likelihood of FLI-defined MASLD regression (HR 1.06; 95% CI 1.00, 1.11). The risk of decompensated hepatic events was comparable (HR 0.99; 95% CI 0.94, 1.03). Dose-stratified analyses yielded consistent findings in both FLI-defined MASLD regression (low-dose: HR 1.19; 95% CI 0.77, 1.83; high-dose: 1.14; 1.01, 1.28) and decompensated hepatic events (low-dose: 0.95; 0.74, 1.23; high-dose: 1.04; 0.93, 1.15). Among individuals with MASLD, no significant differences were observed between empagliflozin and dapagliflozin in the risk of decompensated hepatic events.

논문정보