Dapagliflozin vs Canagliflozin
## Overview
Dapagliflozin and canagliflozin are both SGLT2 inhibitors with significant cardiovascular and renal outcome data. The key differentiation is dapagliflozin's broader non-T2DM indications (HFrEF, HFpEF, CKD without diabetes) and canagliflozin's amputation risk signal.
## Mechanism of Action
Both inhibit SGLT2. Canagliflozin has partial SGLT1 activity at 300 mg. Dapagliflozin is highly selective for SGLT2.
## Clinical Evidence
Dapagliflozin: DAPA-HF (HFrEF ± DM), DELIVER (HFpEF), DAPA-CKD (CKD ± DM). Canagliflozin: CANVAS (CV events in T2DM), CREDENCE (diabetic nephropathy). Dapagliflozin has more FDA-approved non-diabetes indications.
## Safety Consideration
Canagliflozin has a boxed warning for lower-limb amputation. Dapagliflozin does not carry this warning.
## Key Takeaways
- Dapagliflozin: broader non-DM indications, no amputation signal
- Canagliflozin: established CREDENCE data in diabetic nephropathy but amputation risk
- Both effective for T2DM glycemic control, CV, and renal protection
निष्कर्ष
Dapagliflozin is generally preferred over canagliflozin due to broader non-diabetes indications (HFrEF, HFpEF, CKD without DM) and absence of the amputation risk signal. Canagliflozin may be chosen for specific patients where CREDENCE data in diabetic nephropathy is cited, but its amputation risk makes it less preferred in high-risk patients.