Medicines

Cardiovascular benefits of SGLT2 inhibitors may override risk of harm


The cardiovascular benefits of sodium-glucose cotransporter-2 (SGLT2) inhibitors are likely to override the risk of harm in many patients with type 2 diabetes, a new study has found.

However the large systematic review and meta-analysis published online in The Lancet Diabetes & Endocrinology, highlighted significant side effects including increased genital infections, and called for some caution as most of the available data came from a single trial of empagliflozin.

Co-author, Professor Bruce Neal, a senior director of The George Institute for Global Health, and Professor of Medicine at the University of Sydney, said the results looked “very promising” for the SGLT2 class of drugs, but that “we really need confirmation with further trials of other drugs.”

“Fortunately there are several tens of thousands of patients in ongoing large trials of other SGLT2 inhibitors so we should know much more over coming years,” he said.

He told the limbic that the significant take home message for clinicians was that “with clear protection against cardiovascular outcomes, net clinical effects of SGLT2 inhibitors look much more likely to be beneficial than harmful, although important side effects have been identified.”

“Whether there are differences between the individual drugs is hard to tell with the currently available data,” he said.

In a related comment published with the article, Professor John Wilding, head of the Department of Obesity and Endocrinology at the University of Liverpool, UK, said clinicians should “probably not” now embrace the use of SGLT2 inhibitors as “glucose-lowering drugs that provide cardiovascular benefits for all patients with type 2 diabetes.”

“Much of the benefit seems to relate to heart failure and because the effects seen are too rapid to be due to a reduction in atherosclerotic disease, mechanistic studies to fully understand the effects of SGLT2 inhibitors on the heart are essential,” he wrote.

“SGLT2 inhibitors could represent the start of a new era for diabetes treatment, but we should await the results of these ongoing trials before adopting widespread use in the expectation of cardiac benefit, despite the encouraging data from this latest meta-analysis,” he concluded.

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