Concerns about risk of serious urinary tract infections with SGLT2 inhibitors have not been reflected in real world use, the authors of a US study say.

The risk for severe and non-severe UTI events in patients starting SGLT-2 inhibitor therapy was similar to that among patients starting treatment with other antidiabetic medications such as DPP-4 inhibitors or GLP-1 agonists, according to findings published in the Annals of Internal Medicine.

The results are based on analysis of adverse events in two cohorts of patients with type 2 diabetes enrolled with insurance companies.

In a cohort of 123,752 patients the incidence rate for severe UTI events was 1.76 per 1000 person-years for people starting SGLT2 inhibitors compared to 1.77 for those starting a DPP-4 inhibitor.

In a second cohort of 111,978 people the incidence rates for severe UTI were 2.15 for people starting SGLT-2 inhibitors and 2.96 for patients starting a GLP-1 agonist.

There were also no differences in rates of less severe, outpatient -treated UTI between diabetes drugs.

The findings were described as “reassuring” in an accompanying commentary.

“Ultimately, although some uncertainty remains, the study by Dave and colleagues provides encouraging evidence of the real-world safety of SGLT-2 inhibitors, allowing patients to benefit from their use with greater confidence in their safety with respect to severe UTIs,” wrote Dr Kristian B. Filion (PhD) and Dr Oriana H. Yu  of Lady Davis Institute of McGill University and the Jewish General Hospital, Montreal, Canada.

It had previously been thought that the high urinary glucose levels caused by SGLT2 inhibitors might predispose patients to UTIs. In 2015 the FDA  issued a safety alert for the drug class after 19 cases of urosepsis requiring hospitalisation were reported with the SGLT2 inhibitors.