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钠-葡萄糖共转运蛋白 2 抑制剂与膀胱过度活动症药物联合使用与尿路感染风险。

Concomitant Use of Sodium-Glucose Cotransporter 2 Inhibitors and Overactive Bladder Drugs and the Risk of Urinary Tract Infection.

机构信息

School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.

Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea.

出版信息

Clin Pharmacol Ther. 2024 May;115(5):1132-1140. doi: 10.1002/cpt.3182. Epub 2024 Jan 29.


DOI:10.1002/cpt.3182
PMID:38284421
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11023771/
Abstract

Concomitant use of sodium glucose cotransporter-2 inhibitors (SGLT-2i) and overactive bladder (OAB) drugs potentially poses a risk of urinary tract infections (UTIs) due to the urinary retention of highly concentrated glucose in the urine. Thus, this study aimed to investigate the risk of UTIs among patients who initiated SGLT-2i treatment while taking OAB drugs. This population-based cohort study included new-users of SGLT-2i or comparator antidiabetics (dipeptidyl peptidase-4 inhibitor (DPP-4i); glucagon-like peptide-1 receptor agonist (GLP-1RA)) with OAB drugs between 2014 and 2020 using claim data from Korea. Primary outcome was a composite UTI event composite end point comprising pyelonephritis, cystitis, and urethritis, using both inpatient and outpatient diagnoses. Propensity score fine stratification was used to adjust for potential confounding factors. Weighted hazard ratios (HR) were calculated using the Cox proportional hazards model. In the first cohort, 796 and 9,181 new-users of SGLT-2i and DPP-4i with OAB drugs were identified, respectively. This study found a similar risk of UTIs in concomitant users of SGLT-2i and DPP-4i (weighted HR 1.08, 95% confidence interval: 0.88-1.32) with OAB drugs. In the second cohort, 2,387 and 280 new-users of SGLT-2i and GLP-1RA with OAB drugs were identified, respectively. Initiation of SGLT-2i while on OAB treatment was not associated with increased risk of UTI (0.89, 0.50-1.60), compared with initiation of GLP-1RA. These results show that the concomitant use of SGLT-2i with OAB drugs was not associated with an increased risk of UTI compared with the concomitant use of DPP-4i or GLP-1RA with OAB drugs.

摘要

同时使用钠-葡萄糖共转运蛋白 2 抑制剂(SGLT-2i)和膀胱过度活动症(OAB)药物可能会导致尿路感染(UTI)的风险,因为尿液中高度浓缩的葡萄糖会导致尿潴留。因此,本研究旨在调查同时使用 SGLT-2i 和 OAB 药物治疗的患者发生 UTI 的风险。这项基于人群的队列研究纳入了 2014 年至 2020 年期间使用 OAB 药物的 SGLT-2i 或对照抗糖尿病药物(二肽基肽酶-4 抑制剂(DPP-4i);胰高血糖素样肽-1 受体激动剂(GLP-1RA))的新使用者,使用的是来自韩国的索赔数据。主要结局是包括肾盂肾炎、膀胱炎和尿道炎在内的复合 UTI 事件复合终点,使用的是住院和门诊诊断。采用倾向评分精细分层来调整潜在的混杂因素。使用 Cox 比例风险模型计算加权风险比(HR)。在第一个队列中,分别确定了 796 名和 9181 名新使用 SGLT-2i 和 DPP-4i 并同时使用 OAB 药物的患者。这项研究发现,同时使用 SGLT-2i 和 DPP-4i 的患者的 UTI 风险相似(加权 HR 1.08,95%置信区间:0.88-1.32)。在第二个队列中,分别确定了 2387 名和 280 名新使用 SGLT-2i 和 GLP-1RA 并同时使用 OAB 药物的患者。与开始使用 GLP-1RA 相比,开始使用 SGLT-2i 并同时使用 OAB 药物并不会增加 UTI 的风险(0.89,0.50-1.60)。这些结果表明,与同时使用 DPP-4i 或 GLP-1RA 相比,SGLT-2i 与 OAB 药物同时使用与 UTI 风险增加无关。

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引用本文的文献

[1]
SGLT2 inhibitors do not cause de novo urinary incontinence in diabetic female patients with chronic kidney disease.

Int Urol Nephrol. 2025-7-1

[2]
Sodium-Glucose Co-Transporter 2 Inhibitors and Severe Urinary Tract Infections: Real-World Meta-Analysis of Cohort Studies.

Ann Pharmacother. 2025-10

本文引用的文献

[1]
Burden of diabetes and hyperglycaemia in adults in the Americas, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.

Lancet Diabetes Endocrinol. 2022-9

[2]
Gliflozins in the Management of Cardiovascular Disease.

N Engl J Med. 2022-5-26

[3]
Risk of Opioid Overdose Associated With Concomitant Use of Oxycodone and Selective Serotonin Reuptake Inhibitors.

JAMA Netw Open. 2022-2-1

[4]
The Association Between Urinary Tract Infection and Overactive Bladder Treatment.

Front Pharmacol. 2022-1-25

[5]
Effectiveness and safety of sodium-glucose co-transporter-2 inhibitors compared with dipeptidyl peptidase-4 inhibitors in older adults with type 2 diabetes: A nationwide population-based study.

Diabetes Obes Metab. 2021-3

[6]
Mechanisms of Cardiorenal Effects of Sodium-Glucose Cotransporter 2 Inhibitors: JACC State-of-the-Art Review.

J Am Coll Cardiol. 2020-2-4

[7]
Sodium-Glucose Cotransporter-2 Inhibitors and the Risk for Severe Urinary Tract Infections: A Population-Based Cohort Study.

Ann Intern Med. 2019-7-30

[8]
Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019.

J Urol. 2019-8-8

[9]
Long-term Safety and Efficacy of Mirabegron and Solifenacin in Combination Compared with Monotherapy in Patients with Overactive Bladder: A Randomised, Multicentre Phase 3 Study (SYNERGY II).

Eur Urol. 2018-6-1

[10]
SGLT-2 inhibitors and the risk of infections: a systematic review and meta-analysis of randomized controlled trials.

Acta Diabetol. 2018-2-27

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