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Steglatro Vs Jardiance (Ertugliflozin Vs Empagliflozin)

Steglatro Vs Jardiance

steglatro vs jardiance

Steglatro vs Jardiance is a comparison of the efficacies of the two drugs in patients with diabetes. The two drugs have not been compared in head-to-head clinical trials. Apart from their efficacies, other characteristics of Jardiance and Steglatro have also been compared here. These include their dosages, formulations, efficacy in obese patients, kidney disease, and their benefits in patients with heart failure.

Non-Insulin Dependent Diabetes Mellitus (NIDDM) T2DM

Both Steglatro and Jardiance belong to the same class of medicines called SGLT2 Inhibitors. As a class effect, these drugs cause glucose excretion in the urine by inhibiting the Sodium-Glucose Receptors Type 2 (SGLT2 receptors) in the kidney tubules.

SGLT2 receptors enhance the reabsorption of filtered glucose back to the blood. Blocking these receptors, Steglatro and Jardiance both increase the glucose excretion in the urine.

Jardiance Vs Farxiga: The Better Vs The Best SGLT2 Inhibitor

Steglatro Vs Jardiance (Ertugliflozin Vs Empagliflozin): Which drug is more specific?

Ertugliflozin are Empagliflozin are both specific SGLT2 receptor inhibitors. However, Ertugliflozin (Steglatro) is less specific compared to Empagliflozin (Jardiance). Ertugliflozin is 2000 times specific while Empagliflozin is 2500 times specific for SGLT2 receptors compared to SGLT1 receptors.

Because both the drugs specifically block SGLT2 receptors, they are very effective in lowering glycated hemoglobin.

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Furthermore, Ertugliflozin has 100% bioavailability. This means the drug is absorbed efficiently from the gastrointestinal tract. Also, Steglatro has a longer half-life and a shorter peak onset of action resulting in sustained and rapid blood glucose-lowering effects.

Here is a summary of the pharmacokinetic effects of Steglatro and Jardiance:

Steglatro

Jardiance

Class of Drug SGLT2 Inhibitor SGLT2 Inhibitor
Generic Name Ertugliflozin Empagliflozin
Specificity for SGLT2 Receptors 2000 times specific for SGLT2 receptors compared to SGLT1 receptors 5000 times specific for SGLT2 receptors compared to SGLT1 receptors
Bioavailability 100% 78%
Protein-binding 93.6% 86.2%
Peak action 1 hour after administration 1.5 hours after administration
Half-life elimination 16.6 hours 12.4 hours
Excretion 41% is excreted in Urine,

50% in feces

54.4% of the drug is excreted in the urine, 41.2% is excreted in feces.
Metabolism It is metabolized by UGT1A9-mediated O-glucuronidation.

Metabolism by CYP is minimal

It is metabolized by glucoronidation

Jardiance vs Steglatro in Clinical Practice:

Jardiance and Steglatro have subtle differences in pharmacokinetics. However, real patients data and data from clinical trials are important to draw conclusions regarding their efficacy and safety.

Which drug more effectively lowers the blood glucose? Steglatro or Jardiance?

Data regarding the use of Jardiance (Empagliflozin) in patients with Diabetes Mellitus is extensive. It has been studied as monotherapy and in combination with metformin, Sitagliptin, Linagliptin, pioglitazone, Insulin, and Sulfonylureas [Ref].

Efficacy of Jardiance Monotherapy:

  • Jardiance monotherapy resulted in a reduction of glycated hemoglobin by -0.7% and -0.8% when given in doses of 10 mg and 25 mg once daily compared to -0.1% with placebo after 24 weeks of administration.

Glycemic efficacy of Jardiance and Metformin:

  • Metformin 1500 mg per day in combination with Jardiance 10 mg and 25 mg resulted in a reduction in glycated hemoglobin by -0.7% and -0.8% after 24 weeks compared to -0.1% with placebo medicine.

Can You Take Jardiance and Metformin Together?

jardiance efficacy in diabetes monotherapy and combination with metformin

Efficacy of Jardiance in combination with Linagliptin (Tradjenta):

  • Jardiance was studied in patients who had inadequately controlled diabetes on metformin 1500 mg per day. Jardiance 10 mg and 25 mg in combination with Linagliptin 5 mg resulted in significant HbA1C reduction and weight loss compared to placebo.

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Efficacy of Jardiance and Metformin in combination compared to Glimepiride and Metformin combination:

  • Jardiance in combination with metformin was found to have equivalent efficacy compared to Glimepiride and metformin combination. The HbA1C reduction was -0.7% with either of the two treatment groups. However, patients in the Jardiance group had significant weight loss compared to weight gain in the glimepiride group.

jardiance glycemic and weight loss effects when combined with metformin and sulfonylurea

 

Jardiance compared to Pioglitazone:

Patients who were on metformin 1500 mg per day and had poorly controlled diabetes were put on either Jardiance 10 mg or 25 mg. All patients also received pioglitazone 30 mg per day.

The HbA1C reduction in patients in the three groups were as:

  • Jardiance 10 mg + Pioglitazone 30 mg: -0.6%
  • Jardiance 25 mg + Pioglitazone 30 mg: -0.7%
  • Placebo + Pioglitazone: -0.1%

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Glycemic efficacy of Jardiance in combination with Insulin:

Jardiance was given in a dose of 10 mg and 25 mg to patients who also received Insulin. Compared to placebo, the glycemic efficacy in each group was as follows:

  • Jardiance 10 mg in combination with Insulin:
    • HbA1C reduction: -0.4%
  • Jardiance 25 mg in combination with Insulin:
    • HbA1C reduction: -0.6%
  • Placebo + Insulin:
    • HbA1C reduction: +0.1%

 

Glycemic efficacy of Steglatro (Ertugliflozin) [Ref]:

  • In a 26 weeks placebo-controlled trial, Steglatro was administered to patients in a dose of 5 mg and 15 mg once daily. The glycemic efficacy was compared to placebo.
  • Steglatro 5 mg and 15 mg resulted in a reduction in HbA1C by -0.7% and -0.8% respectively compared to 0.2% in patients treated with placebo.

Glycemic efficacy of Steglatro in combination with Metformin:

  • Metformin 1500 mg per day or more in combination with Steglatro 5 mg and 15 mg resulted in an HbA1C reduction of -0.7% and -0.9% compared to -0.2 % with placebo after 26 weeks.

Glycemic efficacy of Steglatro compared to Glimepiride:

  • Diabetic patients who were on metformin were given either Steglatro in a dose of 5 mg and 15 mg or Glimepiride. Glimepiride was initiated in a dose of 1 mg and titrated to a maximum dose of 6 – 8 mg per day. The mean dose of Glimepiride per day was 3 mg.
  • After 52 weeks, Steglatro was found to be non-inferior to Glimepiride. The HbA1C reduction observed with Steglatro 5 mg and 15 mg was -0.5% each compared to -0.6% each.

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Steglatro in combination with Sitagliptin:

  • Steglatro in a dose of 5 mg or 15 mg, when given in combination with Sitagliptin 100 mg per day, was found to be superior to either Steglatro or Sitagliptin monotherapy.

Which drug is best for weight loss: Steglatro or Jardiance?

Jardiance (empagliflozin) and Steglatro (Ertugliflozin) are SGLT2 inhibitors and associated with weight loss because of the glucosuric effects [Ref].

Weight Loss effects of Jardiance Monotherapy:

  • As monotherapy, Jardiance resulted in a significant weight loss compared to placebo after 24 weeks. Jardiance 10 mg and 25 mg caused a weight loss of -2.8 kgs and -3.2 kgs compared to placebo (-0.4 kgs).

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Efficacy of Jardiance in combination with Metformin:

  • Metformin 1500 mg per day in combination with Jardiance 10 mg and 25 mg resulted in weight loss of -2.5 kgs and -2.9 kgs compared to -0.5 kgs with placebo after 24 weeks.

Efficacy of Jardiance and Metformin in combination compared to Glimepiride and Metformin combination:

  • Jardiance in combination with metformin was found to have equivalent glycemic efficacy compared to Glimepiride and metformin combination. However, patients in the Jardiance group had significant weight loss compared to weight gain in the glimepiride group.
  • Patients in the Jardiance and Metformin combination group lost 3.9 kgs vs Glimepiride and metformin combination who gained 2 kgs over 24 weeks period.

jardiance glycemic and weight loss effects when combined with metformin and sulfonylurea

Jardiance compared to Pioglitazone:

  • Patients who were on metformin 1500 mg per day and had poorly controlled diabetes were put on either Jardiance 10 mg or 25 mg. All patients also received pioglitazone 30 mg per day.
  • The weight loss associated with Jardiance compared to Pioglitazone was:
  • Jardiance 10 mg + Pioglitazone 30 mg: -2 kgs
  • Jardiance 25 mg + Pioglitazone 30 mg: -1.8 kgs
  • Placebo + Pioglitazone: +0.6 kgs

Dapagliflozin Side effects, Warnings, and Contraindications

Weight Loss effect of Jardiance in combination with Insulin:

Jardiance was given in a dose of 10 mg and 25 mg to patients who also received Insulin. Compared to placebo, the weight loss associated with Jardiance was as follows:

  • Jardiance 10 mg in combination with Insulin:
    • Weight reduction: -2.4 kgs
  • Jardiance 25 mg in combination with Insulin:
    • Weight reduction: -2.4 kgs
  • Placebo + Insulin:
    • Weight reduction: +0.7 kgs

Weight loss effects of Steglatro (Ertugliflozin):

  • In a 26 weeks placebo-controlled trial, Steglatro was administered to patients in a dose of 5 mg and 15 mg once daily. The weight loss effect was compared to a placebo.
  • Steglatro 5 mg and 15 mg resulted in a weight loss of 3.0 kgs and 3.1 kgs respectively compared to 1 kg in patients treated with placebo.

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Weight loss effect of Steglatro in combination with Metformin:

  • Metformin 1500 mg per day or more in combination with Steglatro 5 mg and 15 mg resulted in weight loss of -3.2 kgs and -3 kgs compared to -1.4 kgs with placebo after 26 weeks.

Weight Loss effects of Steglatro compared to Glimepiride:

  • Diabetic patients who were on metformin were given either Steglatro in a dose of 5 mg and 15 mg or Glimepiride. Glimepiride was initiated in a dose of 1 mg and titrated to a maximum dose of 6 – 8 mg per day. The mean dose of Glimepiride per day was 3 mg.
  • After 52 weeks, Steglatro was found to be superior in terms of weight loss compared to Glimepiride. The weight loss associated with Steglatro 5 mg and 15 mg was -2.6 kgs, -3.0 kgs vs weight gain of 0.6 kgs in the glimepiride group.

Which drug is best for cardiac patients: Steglatro or Jardiance?

Steglatro (Ertugliflozin) has been studied in patients with cardiovascular diseases. Compared to a placebo, it was non-inferior. Fewer incidences of heart failure were noted in the Steglatro group compared to placebo. However, the incidence of major cardiovascular events were similar in both groups [Ref].

Jardiance (Empagliflozin) has been studied in patients with heart failure with reduced ejection fraction and heart failure with preserved ejection fraction.

SGLT2 Inhibitors, Indications, MOA, Use in CKD and CVD

In one study published in NEJM, Jardiance resulted in reduced risk of hospitalization due to heart failure, reduced risk of death from any cause, and lower rates of death from cardiovascular causes compared to placebo in diabetic patients [Ref]. Jardiance, however, did not lower the incidence of Stroke or Myocardial infarction compared to placebo.

Jardiance was also found to be beneficial in patients with heart failure and preserved ejection fraction. It lowered the rates of hospitalization due to heart failure in patients with or without diabetes [Ref].

So, compared to Steglatro, Jardiance seems to have superior cardiovascular benefits.

Which drug is best for kidney patients: Steglatro or Jardiance?

Jardiance has not been studied in patients with advanced kidney disease. These include all patients with eGFR of less than 30 ml/minute, ESRD, and patients on dialysis. In patients with mild to moderate renal impairment, apart from lowering glycated hemoglobin, Jardiance may be protective. It reduced the progression of microalbuminuria to microalbuminuria.

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Contrary to Jardiance, Steglatro is only effective in patients with mild renal impairment. In clinical trials, it did not result in any lowering of glycated hemoglobin or had a beneficial effect on the kidneys. Rather, paradoxically, the risk of worsening renal impairment, progression of kidney impairment, and volume depletion resulting in renal injury was commonly observed in the clinical trials [Ref].

Thus, Jardiance seems to have a better renal safety profile compared to Steglatro.

Here is a summary of the differences between Jardiance and Steglatro:

Jardiance

Steglatro

Usual Dose 10 mg and 25 mg. The maximum dose is 25 mg per day 5 mg and 15 mg. The maximum daily dose is 15 mg.
Dosage Strengths 10 mg and 25 mg 5, 10, and 15 mg
Available Combinations Available in combination with:

  • Metformin: Jardiance Met, and jardiance Duo
  • Triple combination with Sitagliptin and metformin: TriJardy Xr
Available in combination with:

  • Metformin: Segluromet
  • Sitagliptin: Steglujan
Per tablet Price in the US USD 582 per month (10 mg and 25 mg Tablets) Steglatro 5 mg costs USD 333 per month.
Renal Outcome Jardiance has been studied in patients with mild and moderate kidney impairment. It reduced the incidence of diabetic kidney disease and prevents the progression of microalbuminuria to macroalbuminuria.

It can be used in moderate renal impairment, unlike Steglatro.

Ertugliflozin resulted in fewer deaths from renal causes and creatinine doubling occurred in fewer patients in the Ertugliflozin group compared to the placebo [Ref].

However, it is not effective in moderate renal impairment and may worsen the kidney impairment in patients with moderate to severe renal impairment.

Efficacy in Diabetes Jardiance lowers the glycated hemoglobin by -0.7 to -0.9%. It has almost a similar efficacy as Steglatro. HbA1C reduction with 5 mg and 15 mg were -0.7% and -0.8% after 26 weeks compared with a -0.2% reduction in the placebo group.
Weight loss effects The weight loss effect of Jardiance in clinical trials is significant compared to placebo. It is associated with a weight loss ranging from 2 kgs to 3.9 kgs. Weight loss associated with 5 mg and 15 mg was -3 kgs and -3.1 kgs after 26 weeks compared with a -1kgs weight loss in the placebo group.
Use in heart failure Jardiance has been studied in diabetic and non-diabetic patients with heart failure. It lowers the rates of hospitalizations in patients with reduced ejection fraction as well as preserved ejection fraction.

Compared to Steglatro, it is considered to have a superior cardiovascular safety profile.

Ertugliflozin was non-inferior to placebo in terms of hospitalization for heart failure and cardiovascular deaths. In a study in NEJM, death from CVD or hospitalization due to heart failure occurred in 8.1% of patients in the Ertugliflzoin group and 9.3% in the placebo group [Ref]

Empagliflozin (Jardiance) Uses, Dose, MOA, Brands, Side effects

What do you think?

Written by Diabetes Doctor

I am an Internist practicing medicine for the last fifteen years. Over the years, I have learned that medicine is not about prescribing pills. True medical practice is helping people.
I do prescribe pills as well but the best results I get are when I motivate people to overcome their problems with little changes in their lifestyles.
Since most of my patients are obese, have diabetes, hypertension, high cholesterol levels, I am writing at dibesity.com when free.
Dibesity, I know the correct word is diabesity. Ignore this! Be with us.

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