Bexagliflozin is a newer sodium-glucose cotransporter 2 (SGLT2) inhibitor approved for the treatment of type 2 diabetes mellitus (T2DM), although its comparative efficacy within the SGLT2 inhibitor class remains unclear. A network meta-analysis published in Frontiers in Endocrinology evaluated the efficacy and safety of bexagliflozin compared with other SGLT2 inhibitors in adults with T2DM.
The analysis included randomized controlled trials (RCTs) identified through searches of PubMed, Embase, Web of Science, and ClinicalTrials.gov through January 2026. A total of 48 studies involving 26,838 participants were included. Risk of bias was assessed using the Cochrane tool, while evidence certainty was evaluated using the Confidence in Network Meta-Analysis (CINeMA) framework.
Findings
- Bexagliflozin significantly reduced HbA1c, fasting plasma glucose (FPG), body weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP) compared with placebo.
- For HbA1c reduction, canagliflozin 300 mg, canagliflozin 100 mg, and empagliflozin 25 mg were more effective than bexagliflozin, while bexagliflozin was comparable to other SGLT2 inhibitors.
- For FPG reduction, canagliflozin 300 mg and empagliflozin 25 mg showed slightly greater effects than bexagliflozin, with no significant differences between bexagliflozin and other comparators.
- For weight reduction, bexagliflozin was superior to dapagliflozin 5 mg but slightly inferior to canagliflozin 300 mg, while showing comparable efficacy to other SGLT2 inhibitors.
- Bexagliflozin showed similar SBP and DBP reductions to other SGLT2 inhibitors, with greater DBP lowering than empagliflozin 10 mg; it also had lower urinary tract infection incidence than dapagliflozin 5 mg and 10 mg, with comparable safety to other agents and placebo.
Bexagliflozin demonstrated efficacy comparable to most SGLT2 inhibitors for glycemic control, weight reduction, and blood pressure lowering in T2DM, while canagliflozin 300 mg showed greater efficacy for glycemic and weight outcomes.
