Abstract: TH-OR100
Safety Outcomes of Sodium-Glucose Cotransporter-2 Inhibitors in Patients with Diabetes Mellitus and Cancer
Session Information
- Onconephrology and Precision Pharmacology
November 02, 2023 | Location: Room 107, Pennsylvania Convention Center
Abstract Time: 05:51 PM - 06:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Shaikh, Aisha, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Flory, James H., Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Knezevic, Andrea, Memorial Sloan Kettering Cancer Center, New York, New York, United States
- Jaimes, Edgar A., Memorial Sloan Kettering Cancer Center, New York, New York, United States
Background
Sodium-glucose co-transporter-2 (SGLT2) inhibitors are glucose-lowering agents that reduce the risk of hospitalization for heart failure and chronic kidney disease progression. The risk of serious adverse events with SGLT2i use was low in large clinical trials, but patients with cancer were excluded from these trials. Therefore, the safety of SGLT2 inhibitors in patients with cancer is unknown.
Methods
Using our institute's electronic medical record system, we identified 5,478 patients with a history of diabetes mellitus and cancer who were prescribed an SGLT2 inhibitor, i.e., empagliflozin, dapagliflozin, canagliflozin or ertugliflozin, between 2013 and 2022. Data on adverse events, including urinary tract infections (UTIs), diabetic ketoacidosis (DKA), genital infections, and non-vertebral fractures, were collected using the ICD-9/10 diagnostic codes.
Results
The medical record query identified 5,478 patients who were prescribed an SGLT2 inhibitor. Each patient had a start and an end date for the SGLT2 inhibitor prescription, which added up to a total of 11,175 patient-years on SGLT2 inhibitors. The ICD diagnosis query revealed 424 instances of adverse events coinciding with the SGLT2 inhibitor prescription. The incidence rate of adverse events is shown in Table 1.
Conclusion
In this cohort of diabetic patients with cancer, the incidence rate of DKA in patients taking an SGLT2 inhibitor was higher (5.1 per 1000 patient-years) as compared to the incidence rate of DKA reported in a recent meta-analysis1 of SGLT2 inhibitor trials (0.0-2.2 per 1000 patient-years) and a large observational study2 (2.37 per 1000 patient-years). We also observed a high incidence rate of UTIs, genital mycotic infections, and non-vertebral fractures. To our knowledge, this is the first study to report the safety outcomes of SGLT2 inhibitors in diabetic patients with cancer.
1Impact of diabetes on the effects of SGLT2 inhibitors on kidney outcomes. Lancet. 2022
2Comparative Effectiveness and Safety of SGLT2 Inhibitors Versus GLP1-RA in Older Adults. Diabetes Care. 2021
Incidence of adverse events of interest
| Diabetic patients (5478 patients, 11,175 patient-years) | |||
| Diagnosis | Incidence | Per 1000 patient-years | No. of patients (%) |
| UTI | 265 | 23.7 | 187 (3.4%) |
| DKA | 57 | 5.1 | 49 (0.9%) |
| GENITAL INFECTIONS | 54 | 4.8 | 43 (0.8%) |
| NON-VERTEBRAL FRACTURES | 48 | 4.3 | 30 (0.5%) |