Hyperkalemia and hypokalemia consistently reported less frequently with SGLT2i compared to other antidiabetics: Study
China: In real-world scenarios, SGLT-2 inhibitors showed lower and more consistent reports of hyperkalemia and hypokalemia compared to other diabetes treatments, a recent pharmacovigilance study has revealed.
There were significantly fewer hyperkalemia reports among those using SGLT-2 inhibitors in combination with renin–angiotensin–aldosterone system (RAAS) inhibitors or mineralocorticoid receptor antagonists (MRAs) compared to those using RAAS inhibitors or MRAs alone. The findings were published online in the Journal of Cardiovascular Medicine.
SGLT-2 inhibitors are a class of medications commonly prescribed to manage type 2 diabetes by promoting the excretion of glucose in urine. While generally effective, concerns have arisen regarding potential electrolyte imbalances, including changes in serum potassium levels, which can have significant clinical implications.
New trials indicated the potential of SGLT2 inhibitors to reduce hyperkalemia, which might have important clinical implications, but real-world data are limited. Therefore, Rong Li, MD, PhD, The Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China, and colleagues examined the effect of SGLT2i on hyper- and hypokalemia occurrence using the FDA adverse event reporting system (FAERS).
For this purpose, they retrospectively queried the FAERS database from 2004q1 to 2021q3. Disproportionality analyses were performed based on the reporting odds ratio (ROR).
The study led to the following findings:
· There were 84 601 adverse event reports for SGLT2i and 1 321 186 reports for other glucose-lowering medications.
· The hyperkalemia reporting incidence was significantly lower with SGLT2i than other glucose-lowering medications (ROR, 0.83).
· Reductions in hyperkalemia reports did not change across a series of sensitivity analyses.
· Compared with that with renin–angiotensin–aldosterone system inhibitors (RAASi) alone (ROR, 4.40), the hyperkalemia reporting incidence was disproportionally lower among individuals using RAASi with SGLT2i (ROR, 3.25).
· Compared with mineralocorticoid receptor antagonists (MRAs) alone, the hyperkalemia reporting incidence was also slightly lower among individuals using MRAs with SGLT-2i.
· The reporting incidence of hypokalemia was lower with SGLT2i than other antihyperglycemic agents (ROR, 0.79).
In conclusion, In a real-world setting, hypokalemia and hyperkalemia were robustly and consistently reported less frequently with SGLT2 inhibitors than with other diabetes medications. There were disproportionally fewer reports of hyperkalemia among those using SGLT-2is with RAASi or MRAs than those using RAASi or MRAs alone.
Reference:
Yu, Meng, et al. "Sodium-glucose Cotransporter-2 Inhibitors and Abnormal Serum Potassium: a Real-world, Pharmacovigilance Study." Journal of Cardiovascular Medicine (Hagerstown, Md.), vol. 25, no. 8, 2024, pp. 613-622.
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