Filippas-Ntekouan Sebastian, Filippatos Theodosios D, Elisaf Moses S
a Department of Internal Medicine, School of Medicine , University of Ioannina , Ioannina , Greece.
Postgrad Med. 2018 Jan;130(1):72-82. doi: 10.1080/00325481.2018.1394152. Epub 2017 Oct 27.
Sodium-glucose linked transporter type 2 (SGLT2) inhibitors are a relatively new class of antidiabetic drugs with positive cardiovascular and kidney effects. The aim of this review is to present the safety issues associated with SGLT2 inhibitors. Urogenital infections are the most frequently encountered adverse events, although tend to be mild to moderate and are easily manageable with standard treatment. Although no increased acute kidney injury risk was evident in the major trials, the mechanism of action of these drugs requires caution when they are administered in patients with extracellular volume depletion or with drugs affecting renal hemodynamics. Canagliflozin raised the risk of amputations and the rate of fractures in the CANVAS trial, although more data are necessary before drawing definite conclusions. The risk of euglycemic diabetic ketoacidosis seems to be minimal when the drugs are prescribed properly. Regarding other adverse events, SGLT2 inhibitors do not increase the risk of hypoglycemia even when co-administered with insulin, but a decrease in the dose of sulphonylureas may be needed. The available data do not point to a causative role of SGLT2 inhibitors on malignancy risk, however, these drugs should be used with caution in patients with known hematuria or history of bladder cancer. SGLT2 inhibitors seem to be safe and effective in the treatment of diabetes but more studies are required to assess their long-term safety.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂是一类相对较新的抗糖尿病药物，对心血管和肾脏具有积极作用。本综述的目的是阐述与SGLT2抑制剂相关的安全问题。泌尿生殖系统感染是最常出现的不良事件，不过往往为轻至中度，采用标准治疗易于处理。尽管在主要试验中未发现急性肾损伤风险增加，但在细胞外液量减少的患者或使用影响肾血流动力学的药物时，使用这些药物的作用机制需要谨慎考虑。在CANVAS试验中，卡格列净增加了截肢风险和骨折发生率，不过在得出明确结论之前还需要更多数据。如果正确使用这些药物，正常血糖性糖尿病酮症酸中毒的风险似乎极小。关于其他不良事件，SGLT2抑制剂即使与胰岛素联合使用也不会增加低血糖风险，但可能需要减少磺脲类药物的剂量。现有数据并未表明SGLT2抑制剂对恶性肿瘤风险有因果关系，然而，对于已知有血尿或膀胱癌病史的患者，应谨慎使用这些药物。SGLT2抑制剂在糖尿病治疗中似乎是安全有效的，但需要更多研究来评估其长期安全性。
