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Safety and Tolerability of SGLT2 Inhibitors in Cardiac Amyloidosis—A Clinical Feasibility Study

Steinhardt, Maximilian J. ; Cejka, Vladimir ; Chen, Mengmeng ; Bäuerlein, Sabrina ; Schäfer, Julia ; Adrah, Ali ; Ihne-Schubert, Sandra M. LU ; Papagianni, Aikaterini ; Kortüm, K. Martin and Morbach, Caroline , et al. (2024) In Journal of Clinical Medicine 13(1).
Abstract

Sodium-glucose transport protein 2 inhibitors (SGLT2i) slow the progression of renal dysfunction and improve the prognosis of patients with heart failure. Amyloidosis constitutes an important subgroup for which evidence is lacking. Amyloidotic fibrils originating from misfolded transthyretin and light chains are the causal agents in ATTR and AL amyloidosis. In these most frequent subtypes, cardiac involvement is the most common organ manifestation. Because cardiac and renal function frequently deteriorate over time, even under best available treatment, SGLT2i emerge as a promising treatment option due to their reno- and cardioprotective properties. We retrospectively analyzed patients with cardiac amyloidosis, who received either... (More)

Sodium-glucose transport protein 2 inhibitors (SGLT2i) slow the progression of renal dysfunction and improve the prognosis of patients with heart failure. Amyloidosis constitutes an important subgroup for which evidence is lacking. Amyloidotic fibrils originating from misfolded transthyretin and light chains are the causal agents in ATTR and AL amyloidosis. In these most frequent subtypes, cardiac involvement is the most common organ manifestation. Because cardiac and renal function frequently deteriorate over time, even under best available treatment, SGLT2i emerge as a promising treatment option due to their reno- and cardioprotective properties. We retrospectively analyzed patients with cardiac amyloidosis, who received either dapagliflozin or empagliflozin. Out of 79 patients, 5.1% had urinary tract infections; 2 stopped SGLT2i therapy; and 2.5% died unrelated to the intake of SGLT2i. No genital mycotic infections were observed. As expected, a slight drop in the glomerular filtration rate was noted, while the NYHA functional status, cardiac and hepatic function, as well as the 6 min walk distance remained stable over time. These data provide a rationale for the use of SGLT2i in patients with amyloidosis and concomitant cardiac or renal dysfunction. Prospective randomized data are desired to confirm safety and to prove efficacy in this increasingly important group of patients.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
amyloidosis, chronic kidney disease, heart failure, SGLT2 inhibitors
in
Journal of Clinical Medicine
volume
13
issue
1
article number
283
publisher
MDPI AG
external identifiers
  • scopus:85181948869
ISSN
2077-0383
DOI
10.3390/jcm13010283
language
English
LU publication?
yes
id
160f223c-a8fc-4b87-97a5-688cac933449
date added to LUP
2024-02-13 11:45:08
date last changed
2024-02-13 11:46:50
@article{160f223c-a8fc-4b87-97a5-688cac933449,
  abstract     = {{<p>Sodium-glucose transport protein 2 inhibitors (SGLT2i) slow the progression of renal dysfunction and improve the prognosis of patients with heart failure. Amyloidosis constitutes an important subgroup for which evidence is lacking. Amyloidotic fibrils originating from misfolded transthyretin and light chains are the causal agents in ATTR and AL amyloidosis. In these most frequent subtypes, cardiac involvement is the most common organ manifestation. Because cardiac and renal function frequently deteriorate over time, even under best available treatment, SGLT2i emerge as a promising treatment option due to their reno- and cardioprotective properties. We retrospectively analyzed patients with cardiac amyloidosis, who received either dapagliflozin or empagliflozin. Out of 79 patients, 5.1% had urinary tract infections; 2 stopped SGLT2i therapy; and 2.5% died unrelated to the intake of SGLT2i. No genital mycotic infections were observed. As expected, a slight drop in the glomerular filtration rate was noted, while the NYHA functional status, cardiac and hepatic function, as well as the 6 min walk distance remained stable over time. These data provide a rationale for the use of SGLT2i in patients with amyloidosis and concomitant cardiac or renal dysfunction. Prospective randomized data are desired to confirm safety and to prove efficacy in this increasingly important group of patients.</p>}},
  author       = {{Steinhardt, Maximilian J. and Cejka, Vladimir and Chen, Mengmeng and Bäuerlein, Sabrina and Schäfer, Julia and Adrah, Ali and Ihne-Schubert, Sandra M. and Papagianni, Aikaterini and Kortüm, K. Martin and Morbach, Caroline and Störk, Stefan}},
  issn         = {{2077-0383}},
  keywords     = {{amyloidosis; chronic kidney disease; heart failure; SGLT2 inhibitors}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{MDPI AG}},
  series       = {{Journal of Clinical Medicine}},
  title        = {{Safety and Tolerability of SGLT2 Inhibitors in Cardiac Amyloidosis—A Clinical Feasibility Study}},
  url          = {{http://dx.doi.org/10.3390/jcm13010283}},
  doi          = {{10.3390/jcm13010283}},
  volume       = {{13}},
  year         = {{2024}},
}