Please use this identifier to cite or link to this item: doi:10.22028/D291-36859
Title: Side effects and treatment initiation barriers of sodium-glucose cotransporter 2 inhibitors in heart failure: a systematic review and meta-analysis
Author(s): Vukadinović, Davor
Abdin, Amr
Anker, Stefan D.
Rosano, Giuseppe M. C.
Mahfoud, Felix
Packer, Milton
Butler, Javed
Böhm, Michael
Language: English
Title: European Journal of Heart Failure
Publisher/Platform: Wiley
Year of Publication: 2022
Free key words: Sodium–glucose cotransporter 2 inhibitors
Heart failure
Adverse events
Renal function
DDC notations: 610 Medicine and health
Publikation type: Journal Article
Abstract: Aims Physicians are sometimes reluctant to initiate guideline-directed therapy in patients with heart failure and reduced ejection fraction (HFrEF) due to concerns of adverse events. We explored the risk of hypotension, volume depletion, and acute kidney injury (AKI) on sodium–glucose cotransporter 2 (SGLT2) inhibitors in HFrEF populations. Methods and results We determined summary risk ratios (RRs) by conducting a meta-analysis on reported aforementioned adverse events on SGLT2 inhibitors from randomized controlled trials. We explored robustness of meta-analyses by computing fragility and/or reverse fragility index (FI or RFI) and its corresponding fragility quotient (FQ or RFQ) for each outcome. A total of 10 050 patients with HFrEF entered the final meta-analysis. Hypotension was reported in 4.5% (219/4836) on SGLT2 inhibitors and in 4.1% (202/4846) on placebo (RR 1.09, 95% confidence interval [CI] 0.91–1.31, p = 0.36). An RFI of 21 and RFQ of 0.002 suggest robust findings for hypotension. Volume depletion occurred in 9.4% (473/5019) on SGLT2 inhibitors and in 8.7% (438/5031) on placebo (RR 1.07, 95% CI 0.95–1.21, p = 0.25), respectively. RFI of 19 and RFQ of 0.001 suggest moderately robust findings for volume depletion. AKI was reported in fewer patients (1.9% [95/4888]) on SGLT2 inhibitors than on placebo (2.8% [140/4899]) providing lower incidence of AKI (RR 0.69, 95% CI 0.51–0.93, p = 0.02). FI of 14 and RFQ of 0.001 suggest moderately robust findings for AKI. Conclusion Sodium–glucose cotransporter 2 inhibitor therapy is not associated with a clinically relevant risk of hypotension and volume depletion. Its use reduces the risk of AKI. This analysis supports current guideline recommendations on early use of SGLT2 inhibitors.
DOI of the first publication: 10.1002/ejhf.2584
URL of the first publication:
Link to this record: urn:nbn:de:bsz:291--ds-368595
ISSN: 1879-0844
Date of registration: 18-Jul-2022
Description of the related object: Supporting Information
Related object:
Faculty: M - Medizinische Fakultät
Department: M - Innere Medizin
Professorship: M - Prof. Dr. Michael Böhm
Collections:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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