Use of sodium-glucose co-transporter 2 inhibitors and risk of serious renal events: Scandinavian cohort study
Study (n=29,887 new users SGLT2 inhibitors matched to 29,887 new users dipeptidyl peptidase-4 inhibitors) found use of SGLT2 inhibitors linked to significantly reduced risk of serious renal events (2.6 vs. 6.2 events per 1000 person years; HR 0.42; 95% CI, 0.34 to 0.53).
Source:
British Medical Journal
SPS commentary:
According to an editorial, the results from this well designed study are qualitatively consistent with previous clinical trials and smaller observational studies, and adds new evidence that SGLT2 inhibitors seem preferable to DPP4 inhibitors in patients at risk of developing or worsening diabetic kidney disease. It notes that evidence is mixed regarding whether DPP4 inhibitors prevent progression of diabetic kidney disease, but they do not worsen it. It adds that despite this study’s strengths, the results should be interpreted with some caution; sensitivity analyses supplemented with clinical data suggested a modest degree of unmeasured confounding in the primary analysis, but it suggests that overall, the findings add to the impressive track record for SGLT2 inhibitors. It calls for more pragmatic comparative effectiveness trials in real world settings and more diverse populations, which could add further support for broader access to these drugs.
In a linked analysis, the authors compare the number, timing, strength, and transparency of public safety communications across leading medicines regulators as new risks of SGLT2 inhibitors have emerged. They found that the FDA issued more safety advisories but was not always the first to act. Time lags between regulators were common, suggesting limitations in capacity.