Sodium‐glucose co‐transporter‐2 inhibitors and susceptibility to COVID‐19: A population‐based retrospective cohort study

Abstract

Sodium‐glucose co‐transporter‐2 (SGLT2) inhibitors are widely prescribed in people with type 2 diabetes. We aimed to investigate whether SGLT2 inhibitor prescription is associated with COVID‐19, when compared with an active comparator. We performed a propensity‐score‐matched cohort study with active comparators and a negative control outcome in a large UK‐based primary care dataset. Participants prescribed SGLT2 inhibitors (n = 9948) and a comparator group prescribed dipeptidyl peptidase‐4 (DPP‐4) inhibitors (n = 14 917) were followed up from January 30 to July 27, 2020. The primary outcome was confirmed or clinically suspected COVID‐19. The incidence rate of COVID‐19 was 19.7/1000 person‐years among users of SGLT2 inhibitors and 24.7/1000 person‐years among propensity‐score‐matched users of DPP‐4 inhibitors. The adjusted hazard ratio was 0.92 (95% confidence interval 0.66 to 1.29), and there was no evidence of residual confounding in the negative control analysis. We did not observe an increased risk of COVID‐19 in primary care amongst those prescribed SGLT2 inhibitors compared to DPP‐4 inhibitors, suggesting that clinicians may safely use these agents in the everyday care of people with type 2 diabetes during the COVID‐19 pandemic.

Disentangling conflicting evidence on DPP-4 inhibitors and outcomes of COVID-19: narrative review and meta-analysis

“…The incidence rate of infection was similar among SGLT2i users and DPP4i users (19.7/1000 vs 24.7/1000 person-years). The adjusted HR was 0.92 (95% CI 0.66–1.29) [ 20 ].…”

Diabetes, obesity, metabolism, and SARS-CoV-2 infection: the end of the beginning

“…Although less information is available on users of SGLT-2 inhibitors who develop COVID-19, Sainsbury and colleagues compared reports of new COVID-19 infection in people with T2D using SGLT-2 inhibitors (SGLT-2i, n = 9,948) versus DPP-4 inhibitors (n = 14,917) followed from January 30 to July 27, 2020, in a UK primary care database. The incidence rates for a confirmed or clinically suspected new COVID-19 diagnosis were 19.7 versus 24.7/10,000 patient years for SGLT-2i versus DPP-4 inhibitors, respectively, when comparing propensity matched cohorts (7,676 matched subjects in each group) ( Sainsbury et al., 2021 ). Insufficient information was available to infer differences in severity of illness or rates of mortality.…”

The Association Between Hypoglycemic Agents and Clinical Outcomes of COVID-19 in Patients with Diabetes: A Systematic Review and Meta-Analysis

“…A clinical trial is ongoing in France to assess the efficacy of several repurposed drugs against COVID-19 including repaglinide(18). A propensity-score-matched cohort study also noted the influence of SGLT-2i on susceptibility to COVID-19 in diabetic patients(19). Unsolved queries remain about the effects of GLP-1RA, α-glycosidase inhibitors, and TZDs in patients with COVID-19.…”

“…During the current Coronavirus Disease 2019 (COVID- 19) pandemic, there are a limited number of medications evidenced to be effective in treating COVID-19 patients(1). Although vaccines have been proved effective (2) and received emergent use authorization in some countries, their long-term protective effect is uncertain and unable to protect the already infected population (3)(4)(5).…”

“…A propensity-score-matched cohort study also noted the influence of SGLT-2i on susceptibility to COVID-19 in diabetic patients (19). Unsolved queries remain about the effects of GLP-1RA, α-glycosidase inhibitors, and TZDs in patients with COVID-19.…”