Effect of dapagliflozin on COVID-19 infection and risk of hospitalization

Salgado‐Barreira, Ángel; Seijas‐Amigo, José; Rodríguez‐Mañero, Moisés; Piñeiro‐Lamas, María; Eiras, Sonia; Cordero, Alberto; González-Juanàtey, José Ramón; Figueiras, Adolfo

doi:10.1093/jac/dkad241

Cited by 3 publications

(1 citation statement)

References 23 publications

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“…The included studies had the majority [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] participants in the elderly age group, with mean ages ranging from 58 33,34 to 86 years 42 . Most of the studies had an equal distribution of participants among the sexes 33,35,37,[40][41][42][43]48 , while some studies had a male-predominant population 31,32,34,38,39,49 . The characteristics of the population in the included studies are presented in Supplementary Table 1.…”

Section: Population Characteristicsmentioning

confidence: 99%

SGLT2 Inhibitors in COVID-19: Umbrella Review, Meta-analysis, and Bayesian Sensitivity Assessment

Suresh,

Shamim,

Ghosh

et al. 2024

Preprint

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Background: Several studies have reported a reduced risk of COVID-19-related mortality in patients taking antidiabetic medications. This is an umbrella review, meta-analysis, and Bayesian sensitivity assessment of SGLT2 inhibitors in COVID-19 patients with type 2 diabetes mellitus (T2DM). Methods: A search was conducted in the MEDLINE (PubMed), EMBASE, Cochrane, and ClinicalTrials.gov databases on 5/12/2023. We performed an umbrella review of systematic reviews and meta-analyses on SGLT2i effects in T2DM patients with COVID-19 and critically appraised them using AMSTAR 2.0. Trials investigating SGLT2i use in COVID-19 patients post-hospitalisation and observational studies on prior SGLT2i use among COVID-19 patients were included in the meta-analysis, adhering to the PRISMA guidelines. Results: SGLT2 inhibitors exhibited significantly lower odds of mortality (OR 0.67, 95% CI 0.53-0.84) and hospitalisation (OR 0.84, 0.75-0.94) in COVID-19 patients with T2DM. Bayesian sensitivity analyses corroborated most of the findings, with differences observed in hospitalisation and mortality outcomes. SGLT-2 inhibitors showed an OR of 1.20 (95% CI 0.64-2.27) for diabetic ketoacidosis. Publication bias was observed for hospitalisation but not for mortality. The GRADE assessment indicated a low to very low quality of evidence because of observational studies. Conclusions: Prophylactic use of SGLT2 inhibitors reduces mortality and hospitalization among COVID-19 patients, particularly in diabetic patients. The utility of SGLTi after hospitalization is uncertain and warrants further investigation. Limited efficacy has been observed under critical conditions. Individualized assessment is crucial before integration into COVID-19 management.

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Section: Population Characteristicsmentioning

confidence: 99%

SGLT2 Inhibitors in COVID-19: Umbrella Review, Meta-analysis, and Bayesian Sensitivity Assessment

Suresh,

Shamim,

Ghosh

et al. 2024

Preprint

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Potential use of sodium glucose co-transporter 2 inhibitors during acute illness: a systematic review based on COVID-19

Tisch,

Xourgia,

Exadaktylos

et al. 2024

Endocrine

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Objective SGLT-2i are increasingly recognized for their benefits in patients with cardiometabolic risk factors. Additionally, emerging evidence suggests potential applications in acute illnesses, including COVID-19. This systematic review aims to evaluate the effects of SGLT-2i in patients facing acute illness, particularly focusing on SARS-CoV-2 infection. Methods Following PRISMA guidelines, a systematic search of PubMed, Scopus, medRxiv, Research Square, and Google Scholar identified 22 studies meeting inclusion criteria, including randomized controlled trials and observational studies. Data extraction and quality assessment were conducted independently. Results Out of the 22 studies included in the review, six reported reduced mortality in DM-2 patients taking SGLT-2i, while two found a decreased risk of hospitalization. Moreover, one study demonstrated a lower in-hospital mortality rate in DM-2 patients under combined therapy of metformin plus SGLT-2i. However, three studies showed a neutral effect on the risk of hospitalization. No increased risk of developing COVID-19 was associated with SGLT-2i use in DM-2 patients. Prior use of SGLT-2i was not associated with ICU admission and need for MV. The risk of acute kidney injury showed variability, with inconsistent evidence regarding diabetic ketoacidosis. Conclusion Our systematic review reveals mixed findings on the efficacy of SGLT-2i use in COVID-19 patients with cardiometabolic risk factors. While some studies suggest potential benefits in reducing mortality and hospitalizations, others report inconclusive results. Further research is needed to clarify optimal usage and mitigate associated risks, emphasizing caution in clinical interpretation.

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Why have SGLT2 Inhibitors Failed to Achieve the Desired Success in COVID-19?

Cumhur Cure,

Cure

2024

CPD

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Abstract:: The SARS-CoV-2 virus emerged towards the end of 2019 and caused a major worldwide pandemic lasting at least 2 years, causing a disease called COVID-19. SARS-CoV-2 caused a severe infection with direct cellular toxicity, stimulation of cytokine release, increased oxidative stress, disruption of endothelial structure, and thromboinflammation, as well as angiotensin-converting enzyme 2 (ACE2) down-regulation-mediated renin-angiotensin system (RAS) activation. In addition to glucosuria and natriuresis, sodium-glucose transport protein 2 (SGLT2) inhibitors (SGLT2i) cause weight loss, a decrease in glucose levels with an insulin-independent mechanism, an increase in erythropoietin levels and erythropoiesis, an increase in autophagy and lysosomal degradation, Na+/H+-changer inhibition, prevention of ischemia/reperfusion injury, oxidative stress and they have many positive effects such as reducing inflammation and improving vascular function. There was great anticipation for SGLT2i in treating patients with diabetes with COVID-19, but current data suggest they are not very effective. Moreover, there has been great confusion in the literature about the effects of SGLT2i on COVID-19 patients with diabetes . Various factors, including increased SGLT1 activity, lack of angiotensin receptor blocker co-administration, the potential for ketoacidosis, kidney injury, and disruptions in fluid and electrolyte levels, may have hindered SGLT2i's effectiveness against COVID-19. In addition, the duration of use of SGLT2i and their impact on erythropoiesis, blood viscosity, cholesterol levels, and vitamin D levels may also have played a role in their failure to treat the virus. This article aims to uncover the reasons for the confusion in the literature and to unravel why SGLT2i failed to succeed in COVID-19 based on some solid evidence as well as speculative and personal perspectives.

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Effect of dapagliflozin on COVID-19 infection and risk of hospitalization

Cited by 3 publications

References 23 publications

SGLT2 Inhibitors in COVID-19: Umbrella Review, Meta-analysis, and Bayesian Sensitivity Assessment

SGLT2 Inhibitors in COVID-19: Umbrella Review, Meta-analysis, and Bayesian Sensitivity Assessment

Potential use of sodium glucose co-transporter 2 inhibitors during acute illness: a systematic review based on COVID-19

Why have SGLT2 Inhibitors Failed to Achieve the Desired Success in COVID-19?

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