Background: Sunitinib (SU) and pazopanib (PZ) are standards of care for first-line treatment of metastatic renal cell carcinoma (mRCC). However, how the efficacy of these drugs translates into effectiveness on a population-based level is unknown. Methods: We used the IMDC to assess overall survival (OS), progression-free survival (PFS), response rate (RR) and performed proportional hazard regression adjusting for IMDC prognostic groups. Second-line OS2 and PFS2 were also evaluated. Results: We obtained data from 7438 patients with mRCC treated with either first line SU (n=6519) or PZ (n=919) with an overall median follow-up of 40.4 months (m) (CI95% 39.2 – 42.1). Baseline characteristics are in Table 1. There were no significant differences in IMDC prognostic groups with favorable, intermediate and poor risk patient distributions being 23%, 57%, 20% respectively for sunitinib and 24%, 58%, 18% respectively for pazopanib (p=0.36). There was no OS difference between sunitinib and pazopanib (22.3m vs 22.6m respectively, p=0.65). When adjusted for IMDC criteria, the HR of death for PZ vs SU is 1.03 (95%CI 0.92-1.17, p=0.58). There was no PFS difference between sunitinib and pazopanib (8.4m vs 8.3m respectively, p=0.17). When adjusted for IMDC criteria, the HR for PFS for PZ vs SU 1.08 (95%CI 0.981-1.19, p=0.12). There was no difference in RR between sunitinib and pazopanib (30% vs 28% respectively, p=0.15). We also found no difference in any second-line treatment between either post-SU vs. post-PZ groups for OS2 (12.8m vs. 12.7 m, p=0.91) and PFS2 (3.7 vs. 4.5 m, p=0.50). Conclusions: We confirmed in real-world practice, that SU and PZ have similar efficacy in the first-line setting for mRCC and do not affect outcomes with subsequent second-line treatment.