This article is more than 5 years old. Information may no longer be current.
SGLT-2 inhibitors may not be tied to severe UTI risk
Click Here to Manage Email Alerts
Patients who take sodium-glucose cotransporter-2 inhibitors may not have increased risks for severe or nonsevere UTIs compared with those taking other antidiabetic medications, according to a study published in the Annals of Internal Medicine.
“Although [sodium–glucose cotransporter-2 (SGLT-2)] inhibitors have consistently been shown to increase risk for genital infections, their association with urinary tract infections (UTIs) is less clear, and prior meta-analyses have reported conflicting findings,” Chintan V. Dave, PharmD, of Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote. “Most UTIs caused by SGLT-2 inhibitors are of mild to moderate severity, but in 2015 the [FDA] revised labels for all SGLT-2 inhibitors to add a warning about severe UTIs.”
Researchers assessed associations between SGLT-2 inhibitors and severe UTI events among patients with type 2 diabetes using information from two large databases of commercial insurance claims in the United States.
The study included two cohorts for each database to allow for pairwise comparisons between treatments. Cohort 1 included new users of SGLT-2 inhibitors and dipeptidyl peptidase-4 inhibitors (DPP-4) and cohort 2 included new users of SGLT-2 inhibitors and glucagon-like peptide-1 receptor (GLP-1) agonists.
Researchers evaluated the occurrence of severe UTI events, such as hospitalization for UTI and sepsis with UTI, among the cohorts. Participants in each cohort were matched based on propensity scores.
Cohort 1 included 123,752 patients with type 2 diabetes. A total of 61 (incidence rate = 1.76 per 1,000 person-years) severe UTI events occurred in patients who received SGLT-2 inhibitors and 57 (incidence rate = 1.77 per 1,000 person-years) occurred in patients who received DPP-4 inhibitors (HR = 0.98; 95% CI, 0.68-1.41).
Cohort 2 included 111,978 patients, with 73 (incidence rate = 2.15) severe UTI events among the SGLT-2 inhibitor group and 87 (incidence rate = 2.96) in the GLP-1 agonist group (HR = 0.72; 95% CI, 0.53-0.99).
The use of SGLT-2 inhibitors was not tied to an increased risk for outpatient UTIs in cohort 1 (HR = 0.96; 95% CI, 0.89-1.04) or cohort 2 (HR = 0.91; 95% CI, 0.84-0.99).
In an editorial accompanying the study, Kristian B. Filion, PhD, and Oriana H. Yu, MD, MSc, of McGill University and Lady Davis Institute of the Jewish General Hospital in Montreal, noted that further evidence is needed to determine the associations between SGLT-2 inhibitors and UTIs in high-risk patients and in those with a history of UTIs.
“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 UTI,” they continued. – by Erin Michael
Disclosures: Dave and Yu report no relevant financial disclosures. Filion reports that he is currently collaborating with one of the co-authors (Michael Fralick) as part of a study being conducted by the Canadian Network for Observational Drug Effect Studies (CNODES). Please see study for all other authors’ relevant financial disclosures.