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Safety and tolerability of SGLT2 inhibitors for the treatment of Diabetes Mellitus in Heart Transplant Recipients
Session:
Posters (Sessão 1 - Écran 3) - Cardiologia em Populações Especiais 1
Speaker:
Ricardo Carvalheiro
Congress:
CPC 2023
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.14 Cardiovascular Disease in Special Populations - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Ricardo Carvalheiro; André Ferreira; António Valentim Gonçalves; Rita Ilhão Moreira; Tiago Pereira Silva; Valdemar Gomes; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Diabetes mellitus is common after orthotopic heart transplantation (OHT) due to steroid and tacrolimus induced hyperglycemia. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are well-known for their cardio-renal protective effects. However, little information is published regarding its use in the OHT population, raising concerns about the possibility of genital and urinary infections or other side effects.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The aim of this study was to analyse the safety of SGLT2i in the OHT population. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Retrospective analysis of OHT patients treated with SGLT2i in a single center. The development of side effects was evaluated in this cohort. Furthermore, analytic variables before and 6 months after treatment in patients naïve to SGLT2i before OHT were compared using the paired sample t-test or the Wilcoxon signed-rank test.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> 13 patients (P) with OHT were treated with SGLT2i. Median follow-up after SGLT2i initiation was of 12 months (IQR 10.5-16.5). 12P (92.3%) were male, and the median age was 62 years (IQR 53-71). 3P (23.1%) were under SGLT2i treatment at the time of OHT; 10P (76.9%) started treatment with SGLT2i after OHT, with a median time from transplant to SGLT2i initiation of 36.5 months (IQR 20.8-141.3). Patients were immunosuppressed with prednisolone (100%), mycophenolate mofetil (90%) and tacrolimus (50%) or everolimus (50%). Besides DM, the main comorbidities present were arterial hypertension (90%), chronic kidney disease (70%) and dyslipidaemia (70%). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">No SGLT2i related side effects were reported in the time of follow-up, namely balanitis, vulvovaginitis, urinary tract infections or urinary symptoms, hypoglycemia, dizziness or skin rash. One case of asymptomatic bacteriuria that did not require treatment was reported. There were no episodes of treatment discontinuation during follow-up.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In the 10 patients naïve to SGLT2i before OHT, there were no statistically significant differences in HbA1c, kidney function, lipid profile and NTproBNP before and 6 months after treatment initiation (Table 1), despite a numerical improvement in kidney function and NTproBNP values.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions:</strong> In our cohort of patients with OHT, treatment with SGLT2i was well-tolerated and there were no related side effects. The possibility of employing this medication in the OHT group with a high burden of cardio-renal events is strengthened by this data. </span></span></p>
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