Secondary Benefits to SGLT2 Inhibitor Use in SLE Save

An emulation trial of sodium–glucose cotransporter 2 inhibitors (SGLT2i) in systemic lupus erythematosus (SLE) patients yielded a significantly reduced risk of several cardiorenal complications among patients with SLE and type 2 diabetes (T2D). 

Using insurance-based cohort data and a clinical trial emulation, SLE patient outcomes were compared in those with T2D who received either SGLT2i or dipeptidyl peptidase-4 inhibitors. The primary outcomes were the prevention of cardiovascular, renal, and other clinical outcomes.

A total of 2,165 patients starting SGLT2i and 2,165 PS-matched patients starting DPP4i were compared after a mean followup of 753.1 days. Compared to DPP4i treatment, those treated with SGLT2i recipients had significantly lower risks of:

• incident acute kidney injury (HR 0.49, 95% CI 0.39–0.63)
• chronic kidney disease (HR 0.61, 95% CI 0.50–0.76)
• end-stage renal disease (HR 0.40, 95% CI 0.20–0.80)
• heart failure (HR 0.72, 95% CI 0.56–0.92)
• emergency department visits (HR 0.90, 0.82–0.99)
• severe sepsis (HR 0.61, 95% CI 0.39–0.94)

Not significant were the risks of all-cause mortality, lupus nephritis, myocardial infarction, stroke, hospitalizations, urinary tract infection risk or diabetic ketoacidosis risk and fractures.

Cotherapy with SGLT2i for diabetes, greatly benefited lupus patients who experience far fewer cardiorenal complications complications.