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Real-World Comparative Effectiveness of Canagliflozin Versus Empagliflozin and Dapagliflozin in Patients with Type 2 Diabetes in the United States



While several sodium glucose co-transporter 2 (SGLT2) inhibitors are approved as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus (T2DM), there are no clinical trial data providing head-to-head comparisons of the efficacy and safety of these therapies. Real-world analyses can provide valuable evidence on the effectiveness of competing treatments. This study compared the real-world glycemic effectiveness of SGLT2 inhibitors in individuals with T2DM.


Patients who initiated canagliflozin 300 mg versus empagliflozin 25 mg or dapagliflozin 10 mg were identified from the Optum® De-identified Clinformatics® Extended Data Mart–Date of Death database and propensity score matched. Achievement of HbA1c < 8.0% (Healthcare Effectiveness Data and Information Set [HEDIS] target) and > 9.0% (HEDIS poor control) after 6 months of treatment was calculated.


Post-baseline HbA1c was similar in the canagliflozin and empagliflozin cohorts (7.65% versus 7.57%), as was percent of patients with HbA1c < 8.0% or > 9.0%. Post-baseline HbA1c was lower with canagliflozin versus dapagliflozin (7.58% versus 7.74%; P = 0.0247). The canagliflozin cohort was more likely to achieve HbA1c < 8.0% than the dapagliflozin cohort (P = 0.0292); the likelihood of achieving HbA1c > 9.0% was similar.


In patients with T2DM, HbA1c outcomes were similar with canagliflozin and empagliflozin. Patients on canagliflozin versus dapagliflozin were more likely to have a lower HbA1c and reach HbA1c < 8.0% after 6 months. These results may provide important information for clinicians as they decide the appropriate treatment for their patients with T2DM.

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Sponsorship for this study and the journal’s Rapid Service Fee were funded by Janssen Scientific Affairs, LLC (Titusville, NJ, USA). Canagliflozin has been developed by Janssen Research & Development, LLC in collaboration with Mitsubishi Tanabe Pharma Corporation (Chūō-ku, Japan).

Medical Writing, Editorial, and Other Assistance

The authors thank Deepti Bisht of Mu Sigma for data programming support and Michael Pfeifer of Janssen Scientific Affairs, LLC for helpful discussions. Medical writing support was provided by Dana Tabor, PhD, of MedErgy, and was funded by Janssen Scientific Affairs, LLC.


All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.


Lawrence Blonde has served as an investigator for Janssen Pharmaceuticals Inc., Lexicon Pharmaceuticals Inc., Merck & Co., Novo Nordisk, and Sanofi; has served as a speaker for Janssen Pharmaceuticals Inc., Novo Nordisk, and Sanofi; and has served as a consultant for AstraZeneca, Gilead Sciences Inc., Janssen Pharmaceuticals Inc., Merck & Co., Novo Nordisk, and Sanofi. Charmi Patel, Bingcao Wu, Yen-Wen Chen, Christopher D. Pericone, and Brahim Bookhart are employees of Janssen Scientific Affairs, LLC. Charmi Patel and Brahim Bookhart own stock in Johnson & Johnson.

Compliance with Ethics Guidelines

This study is based on de-identified data collected from a health care claims database and does not contain any experimental data with human or animal participants; this analysis was deemed exempt from institutional review board oversight and informed consent was not obtained.

Data Availability

Data for this study were available to the authors via third-party license from Optum, a commercial data provider in the US, and Janssen Pharmaceuticals, which has a license for analysis of the de-identified Optum Clinformatics Extended Data Mart–Date of Death Database. As such, the authors cannot provide the raw data; however, other researchers may access the data by purchase through Optum, and the inclusion criteria specified in the methods would allow them to identify the same cohort of patients. Interested individuals may visit for more information on accessing Optum Clinformatics Extended Data Mart–Date of Death Database.

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Correspondence to Charmi Patel.

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Blonde, L., Patel, C., Wu, B. et al. Real-World Comparative Effectiveness of Canagliflozin Versus Empagliflozin and Dapagliflozin in Patients with Type 2 Diabetes in the United States. Adv Ther 38, 594–606 (2021).

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  • Canagliflozin
  • Dapagliflozin
  • Empagliflozin
  • Glycated hemoglobin
  • Glycemic efficacy
  • Type 2 diabetes mellitus