Farxiga or Brenzavvy for Type 2 Diabetes
The landscape of type 2 diabetes treatment has been signficantly improving with the introduction of new classes of medications. This progress is great news for patients, as it provides a variety of options tailored to different needs. One class of medications that has been gaining popularity is SGLT2 inhibitors, including Jardiance, Farxiga, and Brenzavvy. In this article, we will compare Farxiga and Brenzavvy. While these medications share many similarities due to being in the same class, there are also some important differences. Our goal is to provide a guide to help you choose the right medication for your needs.
How Do They Work for Type 2 Diabetes
The primary difference betwee Farxiga and Brenzavvy lies in their active ingredients. Farxiga contains dapagliflozin, while Brenzavvy contains bexagliflozin. Despite this difference, both medications belong to a class of drugs known as SGLT2 inhibitors, which typically have active ingredients ending in -gliflozin. Although their active ingredients differ, their mechanism of action is the same.
Farxiga and Brenzavvy help lower blood sugar levels by removing excess sugar through urination. Normally, the kidneys filter sugar out of the blood and reabsorb it back into the bloodstream. However, SGLT2 inhibitors like Farxiga and Brenzavvy block this reabsorption process. This means that instead of the sugar being reabsorbed, it is expelled from the body through urine. As a result, blood sugar levels decrease, which can also improve longer-term measures such as A1C levels.
Indications
Both Farxiga and Brenzavvy are used to treat type 2 diabetes in the same way. However, Farxiga has additional approvals for reducing the risk of heart disease. Specifically, Farxiga is indicated for:
- Reducing the risk of heart failure-related hospitalization in adults with type 2 diabetes who already have heart disease or heart-related risk factors.
- Reducing the risk of heart-related hospitalization and death in adults with heart failure and reduced ejection fraction (a condition where the heart doesn't pump blood as effectively as it should).
Side Effects
The common side effects of Farxiga and Brenzavvy occur due to the medications’ mechanism. Since you are urinating increased amounts of sugar, the genital region becomes an ideal environment for bacteria and yeast to grow, increasing your risk of infection.
- Genital fungal (yeast) infections: more common in women than men
- Urinary tract infections
- Increased urination (frequency and/or volume)
Warnings
There are some rare but possible risks associated with SGLT2 inhibitors. The warnings common to both Farxiga and Brenzavvy include:
- Low Blood Sugar (Hypoglycemia): When used with other diabetes medications that can cause low blood sugar, such as insulin or sulfonylureas, the risk of hypoglycemia increases.
- Ketoacidosis: This is a rare condition that occurs when your body can’t use sugars for energy and instead starts using up fat, which breaks down to “ketones”. These build up in the blood causing it to become very acidic, which is dangerous if not treated quickly. Symptoms include nausea, vomiting, stomach pain, confusion, and unusual fatigue
- Low Blood Pressure: Both medications can cause a decrease in the body’s volume of fluid, which can cause low blood pressure. This is most risky for those with poor kidney function, older individuals, and people taking loop diuretics
- Necrotizing Fasciitis (Flesh-eating disease): Necrotizing fasciitis in the genital area has been very rarely linked to the use of both medications. This serious infection often requires hospitalization and surgery, and can even be deadly. If you notice any redness, tenderness, or swelling in the genital region, see a healthcare provider right away to check for necrotizing fasciitis.
In addition to those listed for both medications, Brenzavvy has one additional warning listed in its product information.
- Lower Limb Amputation: This is a rare but possible serious risk particularly in patients with predisposing factors.
Combination Products
Combination products contain more than one medication in a single pill. They are often chosen for convenience, as taking just one pill instead of multiple can decrease the pill.
Farxiga comes in a combination pill named Xigduo XR, which contains dapagliflozin and metformin ER. Metformin is a very common medication for type 2 diabetes and is often the first medication prescribed for the condition. Since an SGLT2 inhibitor like dapagliflozin is often prescribed as adjunct therapy to metformin, it is reasonable for them to be combined in a single pill.
Cost
Price is another significant difference between these medications. A one-month supply of Farxiga costs an average of $650, which is typical for many brand medications for type 2 diabetes. In contrast, Brenzavvy is available for $59.95 at Marley Drug. If cost is a concern, Brenzavvy is a great option for you.
Comparing Brenzavvy and Farxiga Head-to-Head
Brenzavvy was approved 2023 and had not been directly compared with other SGLT2 inhibitors. However, in April 2024, a study titled “Efficacy and Safety of Bexagliflozin Compared with Dapagliflozin as an Adjunct to Metformin in Chinese Patients with Type 2 Diabetes Mellitus: A 24-Week, Randomized, Double-Blind, Active-Controlled, Phase 3 Trial” was published. This multicenter, randomized, double-blind, active-controlled study compared the efficacy and safety of Brenzavvy to Farxiga, which was approved in 2014.
The study found that both medications resulted in a greater than 1% decrease in A1C levels over 24 weeks, with no statistically significant difference between the two. Additionally, both medications produced nearly a 2 mmol/L decrease in fasting blood sugar and over a 3 mmol/L decrease in 2-hour post-meal blood sugar, again with no significant difference between them.
Overall, the results indicate that Brenzavvy is "noninferior" to Farxiga, meaning it is equally effective. This suggests that Brenzavvy, a newer SGLT2 inhibitor, can be considered as effective as Farxiga and potentially other SGLT2 inhibitors.
Regarding safety, there was no statistically significant difference between the two medications. Side effects were reported in just over 60% of individuals in both groups, with severe side effects occurring in around 4% of individuals in each group.
This is promising news for Brenzavvy, as it provides evidence that this medication can be used interchangeably with older and often more expensive SGLT2 inhibitors.
However, it's important to note that this study was conducted specifically in Chinese patients taking metformin. These findings might not be applicable to all populations, as genetic background, lifestyle, and healthcare practices can vary. Therefore, additional studies in diverse populations are needed to determine if these results can be generalized to a broader population.