2025 Fall
International Convention of PSK

D+7
October 22-24, 2025

Abstracts

P12-11

Hepatic effectiveness of empagliflozin versus dapagliflozin in metabolic dysfunction-associated steatotic liver disease

  • Suyeon Kim1, Hwa Yeon Ko1, Bin Hong1, Ju-young Shin*1,2,3
  • 1School of Pharmacy, Sungkyunkwan University, Suwon
  • 2Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon
  • 3Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul

While both empagliflozin and dapagliflozin are known to improve hepatic steatosis and liver enzyme levels, robust Phase Ⅲ 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 effectiveness of empagliflozin versus dapagliflozin in 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 (T2D) and a fatty liver index (FLI) ≥ 60—who initiated empagliflozin or dapagliflozin between May 2016 and December 2023. The index date was the first prescription of empagliflozin or dapagliflozin, with follow-up based on an on-treatment exposure definition. Co-primary outcomes were MASLD regression (achieving FLI < 30) and decompensated hepatic events (ascites, variceal bleeding, hepatic failure, liver transplantation). After 1:1 propensity score (PS) matching, hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox models. Analyses stratified by low (empagliflozin 10 mg; dapagliflozin 5 mg) and high (empagliflozin 25 mg; dapagliflozin 10 mg) doses were further conducted. Among 265,098 new users of empagliflozin and dapagliflozin, 101,495 pairs were 1:1 PS matched (mean age 54.3 years; male 71.2%). Compared with dapagliflozin, empagliflozin was associated with a higher likelihood of MASLD regression (HR 1.06, 95% CI 1.00-1.11), although the result was not statistically significant. The risk of decompensated hepatic events was comparable (HR 0.99, 95% CI 0.94-1.03). Dose-stratified analyses yielded consistent findings, high-dose empagliflozin was associated with a higher likelihood of MASLD improvement (HR 1.14, 95% CI 1.01 to 1.28) than high-dose dapagliflozin. Compared with dapagliflozin, empagliflozin showed similar risk for decompensated hepatic events in both dose-stratified cohorts (low dose: HR 0.95, 95% CI 0.74-1.23; high dose: 1.04, 0.93-1.15). Among patients with MASLD, empagliflozin was more favorable than dapagliflozin for MASLD regression, while both agents showed comparable risks for decompensated hepatic events.


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