SGLT2 Inhibitor Protective Effects in Lupus Save

Systemic lupus erythematosus (SLE) outcomes were assessed based on whether they received sodium-glucose co-transporter 2 inhibitors (SGLT2i), in the setting of comorbid type 2 diabetes (T2D).

An emulated clinical trial used insurance-claims dats from the U.S and identified SLE patients with T2D who either took SGLT2i or dipeptidyl peptidase 4 inhibitors (DPP4i) for primary prevention. After propensity matching, cardiovascular, renal, and other clinical outcomes were assessed. 

A total of 2,165 SLE/T2D patients starting SGLT2i and 2,165 were compared.  After a mean of over 753.1 days, SGLT2i recipients faired better with significantly lower risks of:

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

No between group difference was seen for all-cause mortality (HR 0.89, 0.65-1.21), lupus nephritis (HR 0.67, 0.38-1.15), myocardial infarction (HR 0.81, 0.54-1.23),  stroke (HR 1.03, 0.74-1.44), and hospitalizations (HR 0.76, 0.51-1.12). 

Genital infection were increased (HR 1.31, 1.07-1.61) , but urinary tract infection was not (HR 0.90, 0.79-1.03). Also, there was no significant difference was observed for diabetic ketoacidosis risk (HR 1.065, 0.53-2.14) and fractures (HR 0.95, 0.66-1.36).

SGLT2i use in SLE is preferred as it significantly reduces the risks of several cardiorenal complications with both SLE and T2D.