For most people with type 2 diabetes, metformin is the standard first-line treatment because it is effective, affordable, and has a proven safety record. However, the 2022 American Diabetes Association (ADA) Standards of Care recommend that medications like Invokana and Jardiance be considered as first-line options for people with specific health conditions, such as Chronic Kidney Disease (CKD) or heart disease.
This is particularly relevant because 40% of people with type 2 diabetes are expected to develop CKD, a complication that significantly increases healthcare costs by more than 50% compared to diabetes alone. As a result, choosing a treatment that addresses both diabetes and related conditions can make a meaningful difference.
Even with these options, many people are unsure which medication is best for them. This article will compare Invokana vs Jardiance, focusing on their effectiveness, safety, and additional benefits to better understand the best treatment option.
Efficacy of Invokana Versus Jardiance
Jardiance and Invokana are both SGLT2 inhibitors, but their effectiveness can vary depending on the approved indications. Here’s a comparison:
Jardiance vs Invokana for Type 2 Diabetes
A real-world analysis using data from the US evaluated the effectiveness of Invokana (300 mg) and Jardiance (25 mg) in lowering HbA1c levels in people with type 2 diabetes.
On average, patients taking Invokana had a post-treatment HbA1c of 7.65%, while those on Jardiance had a slightly lower average of 7.57%. The percentage of patients achieving an HbA1c below 8.0% or above 9.0% was also similar between the two groups.
These results suggest that Jardiance and Invokana are equally effective for type 2 diabetes.
Invokana vs Jardiance for Weight Loss
Although Invokana and Jardiance are not specifically approved for weight loss, studies have shown that weight loss can occur as a secondary benefit.
One study showed that Invokana users lost an average of 7.9 lbs, while Jardiance users lost 6.2 lbs. In another paper, Invokana resulted in an average weight loss of 5.1 lbs, compared to 4.3 lbs with Jardiance.
Since these aren’t direct head-to-head trials, it’s difficult to definitively conclude that one drug is more effective than the other for weight loss. The slight differences observed may be influenced by factors like study design, patient characteristics, or statistical adjustments.
For example, a recent study on empagliflozin (Jardiance) found variables influencing weight loss. Men lost more weight than women (7.9 pounds vs. 5.1 pounds), and those with better kidney function also lost more weight. These findings show that individual factors can affect results, regardless of the medication used.
Invokana vs Jardiance for Cardiovascular (CV) Risk Reduction
Jardiance and Invokana both significantly improve cardiovascular outcomes in people with type 2 diabetes. Jardiance reduced major cardiovascular events (MACE) by 14% and hospitalization for heart failure by 35%. Similarly, Invokana reduced MACE by 14% and hospitalization for heart failure by 33%.
However, Jardiance showed faster benefits, reducing MACE risk within 3 months, while Invokana took about 1 year to achieve similar results. Jardiance also reduced cardiovascular death more effectively than Invokana (38% vs. 13%).
A separate study comparing SGLT-2 inhibitors found that both drugs offer similar cardiovascular protection at standard doses. However, Invokana was linked to a higher risk of severe urinary tract infections, which may influence treatment decisions.
Invokana vs Jardiance for Kidney Protection
In the EMPA-KIDNEY trial, Jardiance had a 28% lower risk of chronic kidney disease (CKD) progression or CV death. These results were consistent across all patients, whether or not they had diabetes. Meanwhile, in Invokana’s trials, the risk of end-stage kidney disease (ESKD), worsening of kidney function, or death from kidney or CV causes was 30% lower.
However, results from a real-world study on SGLT2 inhibitors and diabetic kidney disease progression found that Jardiance provided more consistent benefits across all stages of CKD than Invokana.
Jardiance vs Invokana Side Effects
The most common side effect of both drugs is a higher chance of fungal infections in the genital area, such as balanitis (in men) and vulvovaginitis (in women). There is also an increase in the risk of urinary tract infections (UTIs).
Here’s a summary of the adverse reactions reported in over 2% of adults with type 2 diabetes during separate clinical trials for Jardiance and Invokana:
| Side Effect | Invokana | Jardiance |
|---|---|---|
| Urinary tract infections | 4.4% – 5.9% | 7.6% – 9.3% |
| Increased urination | 4.6% – 5.1% | 3.2% – 3.4% |
| Dry mouth and excessive thirst | 2.4% – 2.8% | 1.5% – 1.7% |
| Constipation | 1.8% – 2.4% | Not specified |
| Nausea | 2.1% – 2.3% | 1.1% – 2.3% |
| Female genital mycotic infections | 10.6% – 11.6% | 5.4% – 6.4% |
| Male genital mycotic infections | 3.8% – 4.2% | 1.6% – 3.1% |
| Upper respiratory tract infection | Not reported | 3.1% – 4.0% |
| Dyslipidemia (abnormal cholesterol levels or unhealthy fat levels in the blood) | Not reported | 2.9% – 3.9% |
| Joint pain | Not reported | 2.3% – 2.4% |
Generally, these issues are mild to moderate and usually don’t require stopping the medication. Although rare, serious complications can also occur, including:
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- Diabetic ketoacidosis in patients with type 1 diabetes mellitus and other ketoacidosis
- Lower limb amputation
- Volume depletion, or the decrease in the amount of fluid in the body
- Kidney infections (pyelonephritis) or blood infections caused by UTIs (urosepsis)
- Low blood sugar when used together with insulin or medications that increase insulin production
- Severe infection of the tissue around the genitals, known as Fournier’s gangrene
- Hypersensitivity reactions
- Bone fracture
A 2021 review explored the side effects of Invokana, Jardiance, and other SGLT-2 inhibitors. Specific side effects associated with certain drugs were noted.
For instance, earlier studies linked Invokana to an increased risk of lower limb amputations. However, more recent research has not supported this finding.
Jardiance, in one analysis, was associated with a slight increase in bladder cancer cases, though these occurrences were rare, and further studies are needed to confirm the connection.
Interestingly, Invokana was found to reduce the risk of gastrointestinal cancers, likely due to its strong ability to block SGLT-1 receptors, which are partly found in the digestive tract. Blocking these receptors may help stop the growth of cancer cells in the intestine.
Invokana vs Jardiance Mechanism of Action
Invokana (canagliflozin) and Jardiance (empagliflozin) both target a specific protein in the kidneys called SGLT2 (Sodium-Glucose Co-Transporter-2). This protein functions as a “recycling system,” helping the body reabsorb glucose (sugar) from urine back into the bloodstream.
Under normal conditions, this system ensures that the body retains most of the sugar it filters, so it can use it for energy.
When either of these medications is taken, they block the SGLT2 protein. As a result:
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- Glucose remains in the urine instead of being reabsorbed into the bloodstream.
- The body excretes this excess sugar through urination, which lowers overall blood sugar levels.
By flushing out sugar through the urine, these drugs help lower blood sugar levels during fasting and after meals. They also reduce the burden on the kidneys and other organs, which helps prevent further complications.
Approved Indications of Jardiance and Invokana
Invokana and Jardiance share several similar indications:
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- Glycemic Control: Both are approved as adjuncts to diet and exercise to improve glycemic control in adults and pediatric patients aged 10 years and older with type 2 diabetes mellitus.
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- Cardiovascular Risk Reduction in Type 2 Diabetes: Both reduce the risk of cardiovascular death in adults with type 2 diabetes mellitus and established cardiovascular disease.
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- Kidney Protection: Both are indicated to reduce the risk of kidney-related complications, including end-stage kidney disease and a decline in kidney function, in patients with diabetes or chronic kidney disease.
The difference lies in the scope of the indications:
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- Heart Failure Indication: Jardiance is specifically approved to reduce the risk of cardiovascular death and hospitalization for heart failure in adults with heart failure, regardless of diabetes status. Invokana does not have a specific indication for heart failure in patients without diabetes.
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- Kidney Protection Indication: Invokana specifically targets patients with diabetic nephropathy and albuminuria, while Jardiance provides broader kidney protection in patients with CKD, including those without diabetes.
While they serve similar primary purposes, they offer unique benefits depending on the patient’s underlying conditions.
Dosing Schedules of Invokana vs Jardiance
Below is a side-by-side comparison of the dosing recommendations for Invokana and Jardiance:
| Aspect | Invokana | Jardiance |
|---|---|---|
| Initial Dose (Glycemic Control) | 100 mg once daily, taken before the first meal of the day | 10 mg once daily, taken in the morning, with or without food |
| Maximum Dose (Glycemic Control) | 300 mg once daily (if tolerated) | 25 mg once daily (if tolerated) |
| Renal Function Assessment | Required before initiation and as clinically indicated | Required before initiation and as clinically indicated |
| Use in Renal Impairment | – eGFR 30-59: Max 100 mg once daily. – eGFR less than 30: Not recommended (adults with albuminuria taking 300 mg/day may continue 100 mg daily). | – Not recommended for glycemic control in eGFR <30 mL/min/1.73 m². |
| Volume Depletion | Assess and correct before initiating therapy | Assess and correct before initiating therapy |
| Indications Beyond Glycemic Control | – 100 mg once daily for reducing cardiovascular risks and managing diabetic nephropathy with albuminuria. | – 10 mg once daily for reducing cardiovascular death, heart failure hospitalization, and CKD progression. |
| For concomitant use with UGT enzyme inducers | – eGFR more than or equal to 60: 200 mg once daily, maximum dosage is 300 mg once daily. – eGFR less than 60: Maximum of 200 mg once daily. | Co-treatment with known inducers of UGT enzymes is not recommended. |
| Timing of Administration | Before the first meal of the day | In the morning, with or without food |
Invokana vs Jardiance Cost
Invokana and Jardiance are both brand-name medications, and currently, there are no generic versions available for either. The list price for a 30-day supply of Jardiance (10 mg or 25 mg tablets) is $611.10, while its average retail cost is approximately $859.18. In comparison, the retail price for Invokana typically averages around $808.29 for a month’s supply.
Out-of-pocket expenses for these medications vary widely depending on factors such as:
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- insurance coverage
- pharmacy selection
- location
- any available discounts or assistance programs
Looking ahead, there’s promising news for future pricing. The US government has negotiated lower prices for 10 medications in 2024, including Jardiance. Through direct negotiations with drug companies, Medicare secured a reduced price for Jardiance at $197. However, these changes won’t take effect until January 1, 2026.
Cost-Effectiveness of Jardiance vs Invokana
Studies comparing Jardiance and Invokana show significant differences in cost-effectiveness for preventing hospitalization for heart failure (HHF) or cardiovascular (CV) death in patients with type 2 diabetes. Results showed that the cost of preventing one HHF or CV death event:
-
- Jardiance: approximately $529,828 (range: $391,612-$835,055)
- Invokana: approximately $1,206,348 (range: $787,930-$2,912,624)
Jardiance consistently emerged as a cost-saving strategy, except for patients with a prior history of heart failure.
Another study focusing on patients with type 2 diabetes and heart disease found Jardiance to be both cost-saving and clinically superior to Invokana. It provided 0.38 more quality-adjusted life years (QALYs, a measure of both longer and better-quality life) and cost $306 less.
Summary
Invokana and Jardiance are both effective SGLT2 inhibitors that provide significant benefits for managing type 2 diabetes, cardiovascular risk, and kidney-related complications. While both drugs share similar mechanisms of action, their unique characteristics make each more suitable for specific patient needs.
Jardiance stands out for its broader indications in heart failure and chronic kidney disease, while Invokana offers targeted benefits for diabetic nephropathy and albuminuria. Additionally, Jardiance demonstrates better cost-effectiveness, particularly in reducing cardiovascular events.
Consult a healthcare provider to ensure the choice aligns with individual health conditions and treatment goals.
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