Although the risk of urinary tract infection (UTI) is mentioned in the prescribing information of sodium-glucose cotransporter-2 (SGLT2) inhibitors, there does not appear to be a dose-response relationship between the drug class and UTIs. Findings from this systematic review and network meta-analysis were published in the Canadian Medical Association Journal (CMAJ) Open.
SGLT2 inhibitors are indicated for the treatment of type 2 diabetes mellitus. For this study, the authors identified randomized controlled trials (RCTs) that compared SGLT2 inhibitors with placebo, no treatment, or another antidiabetic agent and reported on UTI outcome. “We used a random-effects model to estimate the pooled effect estimates and 95% credible (CI) intervals,” the authors explained. After a search through 6 databases, a final list of 105 studies were included in the analysis; among these trials, 60,082 patients were represented and 4348 UTIs.
Results of the study showed most of the comparisons were not associated with a significant difference in UTI risk except for when dapagliflozin (high doses of >10mg) was compared with placebo (odds ratio [OR] 1.30, 95% CI 1.09–1.57), with active antidiabetic comparators (OR 1.44, 95% CI 1.15–1.79), with empagliflozin (low dose: OR 1.30, 95% CI 1.04–1.60; high dose: OR 1.39, 95% CI 1.12–1.72), and with ertugliflozin (low dose: OR 1.43, 95% CI 1.01–2.01). However, when data from RCTs with low risk bias (N=57) were analyzed, the results were found to be nonsignificant.
“Our findings are consistent with previous findings supporting a lack of compelling data that would suggest a class effect in terms of UTI risk,” the authors concluded, adding that, “Further studies are needed to quantify the association between SGLT2 inhibitors and more serious infections such as pyelonephritis.”
For more information visit cmajopen.ca.