מילות מפתח: sodium-glucose cotransporter-2 inhibitors, dipeptidyl peptidase-4 Inhibitors, glucagon-like peptide-1 receptor agonist, erythrocytosis, type 2 diabetes, arterial thromboembolism, venous thromboembolism.

רקע מדעי ומטרה:

SGLT2is been shown to induce erythrocytosis. However, the clinical implications of this phenomenon, particularly its association with thrombosis, remain uncertain. We aimed to assess the association of SGLT2is with erythrocytosis and thrombosis.

שיטות:

This nationwide retrospective cohort study aimed to assess the extent, temporal course, and thrombotic complications of SGLT2i-induced erythrocytosis using data from Clalit Health Services between 2015 and 2024. Adult patients with T2D initiating SGLT2is were compared to those initiating DPP4is or GLP-1RAs using a propensity score-matched, active-comparator, new-user cohort design. Outcomes included erythrocytosis within one year of SGLT2i initiation, as well as arterial and venous thrombotic events until end of follow-up.

תוצאות:

After 1:1 propensity score matching, a total of 137,552 adults were included in the SGLT2ivsDPP-4i cohort (68,776 pairs; mean age: 64.5 [12] years; 55.3% male) and 131,512 adults in the SGLT2ivsGLP-1RA cohort (65,756 pairs; mean age: 63.7 [11.9] years; 52% male). Among SGLT2i initiators, erythrocytosis prevalence increased by 5.5-5.8% (95%CI, 5.1%-5.8% and 5.4%-6.2%, respectively), hemoglobin increased by 0.37 g/dL (0.36-0.38) and hematocrit by 1.5% (95%CI, 1.5%-1.5%). Male sex (aOR: 4.12; 95%CI, 3.80-4.48), smoking (aOR: 2.00; 95%CI, 1.85-2.16), and the use of empagliflozin compared to dapagliflozin (aOR: 1.16; 95%CI, 1.09-1.25) were associated with an increased risk of developing erythrocytosis. Erythrocytosis was not associated with an increased risk of MI (HR 0.92; 95%CI: 0.58-1.44), VTE (HR 1.56; 95%CI: 0.68-3.60), or stroke (HR 1.26; 95%CI: 0.84-1.90).

מסקנות:

SGLT2i use was associated with a higher risk of erythrocytosis compared to DPP-4is and GLP-1RAs. However, erythrocytosis was not associated with thrombotic events.

חשיבות לרפואת המשפחה: