Background Sodium-glucose co-transporter 2 (SGLT2) inhibitors are used in patients with type-2 diabetes (T2DM), either alone or in combination with other anti-diabetic drugs, when these medicines together with exercise and diet do not provide adequate control of the diabetes. Dapagliflozin, empagliflozin and canagliflozin are the three SGLT2 inhibitors approved by the European Medicines Agency. SGLT2 inhibitors are associated with a significantly higher risk of recurrent genital and urinary tract infections (UTIs) than placebo and other active anti-diabetics, which may cause treatment discontinuations.
Purpose To evaluate SGLT2 inhibitors’ discontinuation due to recurrent UTIs, in patients with T2DM.
Material and methods A 1 year retrospective, observational study was performed. Patients with an active prescription of SGLT2 during the first 6 months of the study period were selected. Patients that interrupted SGLT2 treatment during the following 6 months were included in our study. The following data was collected: sex, age, cause of discontinuation, antibiotic and/or antifungal drugs prescribed for UTIs and duration of SGLT2 treatment.
Results Six hundred and ninety-one patients with an SGLT2 inhibitor prescription were selected, of which 17 patients (2.5%) interrupted SGLT2 treatment due to recurrent UTIs during the study period, were included in our study. Median treatment duration was 8.8 (2.2–13) months. Ten patients (58.8%) received dapaglyfozin, five patients (29.4%) empaglyfozin and two patients(11.8%) canaglifozyn. Eighty-two per cent (14) of the patients were females: mean age 63. Thirty patients interrupted treatment: 17 (2.5%) because of recurrent UTIs, 13 (2%) because of other medication-related problems. Eight patients had urinary infections, seven patients genital infections and two patients had both genital and urinary infections. UTIs were not specifically monitored during clinical trials. The only available data showed a treatment interruption in 0.7% of the patients who had been treated with canaglifozine. In our study, canaglifozine was interrupted due to UTIs in 1.6% (2/123) of the patients, dapaglifozine in 2.8% (10/351) and empaglifozine in 2.3% (5/217). Only one patient had had previous UTIs. 76.47% (13) of the patients needed antibiotic/antifungal prescriptions: 38.5% (5) fosfomycin, 23.1% (3) ciprofloxacyn, 30.8% (4) clotrimazole, 7.7% (1) fluconazole and 7.7% (1) clindamycin.
Conclusion Patients in treatment with SGLT2 inhibitors have an increased risk of UTIs. Recurrent UTIs significantly impair quality of life. Personal history of UTIs should be considered before initiating SGLT2 inhibitors.
No conflict of interest
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