Med Princ Pract. 2022 Apr 4. doi: 10.1159/000524435. Online ahead of print.
OBJECTIVE: Recent studies have increasingly shown the benefits of using SGLT2i. However, there are concerns about its initiation during acute hospital admissions due to the potential increased risk of complications. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of SGLT2i initiation within two weeks of an acute hospital admission.
METHODS: Four electronic databases (PubMed, Embase, Cochrane, and SCOPUS) were searched for articles published from inception up to 27th March 2021, for studies that evaluated the efficacy and/ or safety of SGLT2i initiation within two weeks of an acute hospital admission. Random-effects pair-wise meta-analysis models was utilized to summarize the studies. The protocol was registered with PROSPERO (CRD42021245492).
RESULTS: Nine clinical trials were included with a combined cohort of 1758 patients. Patients receiving SGLT2i had a mean increase in 24-hour urine volume of +487.55ml (95% CI 126.86 - 848.25; p=0.008) and plasma sodium of +0.55mEq/L (95% CI 0.01 - 1.09; p=0.04), compared to those not started on SGLT2i. Patients with heart failure treated with SGLT2i had a 27% relative risk reduction in rehospitalizations for heart failure, compared to controls (risk ratio 0.73; p=0.005). There were no differences in other efficacy and safety outcomes examined.
CONCLUSION: There was no increased harm with SGLT2i initiation within two weeks of an acute hospital admission, and its use reduced the relative risk of rehospitalizations for heart failure in patients with heart failure. It was also associated with increased urine output and plasma sodium. However, current evidence pool is limited, especially in specific population subtypes.
PMID:35378527 | DOI:10.1159/000524435