Bak Minjung, Chi Sang Ah, Jeon Kina, Hong David, Shin Heayoung, Kim Darae, Choi Jin-Oh
Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Biomedical Statistics Center, Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea.
Sci Rep. 2024 Dec 28;14(1):30653. doi: 10.1038/s41598-024-71231-7.
Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are the only medications that improve clinical outcomes regardless of baseline left ventricular ejection fraction. Despite the recognized effectiveness of SGLT-2 inhibitors, there remains a paucity of research on the discontinuation of these medications. The objective of this study is to analyze the rate of discontinuation of SGLT-2 inhibitors, to evaluate the impact of discontinuation on the clinical outcome, and to identify the factors associated with discontinuation. From 2015 to 2021, 775 heart failure patients prescribed an SGLT-2 inhibitor were retrospectively collated at Samsung Medical Center, Seoul, Republic of Korea. The SGLT-2 inhibitor discontinuation rate and the effect of SGLT-2 inhibitor discontinuation on clinical outcome were analyzed using the Kaplan-Meier survival curve. Factors related to discontinuation were analyzed through Cox regression and competing risk survival analysis. The discontinuation rate of SGLT-2 inhibitors was 7.5% at 1 year and 20% at 5 years. General weakness, over-diuresis and volume depletion, renal dysfunction progression, and urinary tract infections are the major reasons for discontinuing SGLT-2 inhibitors in general medical practice. The group that stopped using SGLT-2 inhibitors had a higher rate of heart failure hospitalization than the control group (adjusted HR 2.600, 95% CI [1.233-5.481], P = 0.012). In multivariable Cox regression analysis, the factors associated with total SGLT-2 inhibitor discontinuation were women (HR 2.478, 95% CI [1.553-3.953], P < 0.001) and lower estimated glomerular filtration rate (eGFR) (HR 0.884 per 10 ml/min/1.73 m, 95% CI [0.789-0.991], P = 0.034). Patients who discontinued SGLT-2 inhibitors experienced an increased risk of heart failure hospitalization, and the rate of discontinuation was higher in women and those with lower eGFR.
钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂是唯一一类无论基线左心室射血分数如何均能改善临床结局的药物。尽管SGLT-2抑制剂的有效性已得到认可，但关于停用这些药物的研究仍然很少。本研究的目的是分析SGLT-2抑制剂的停药率，评估停药对临床结局的影响，并确定与停药相关的因素。2015年至2021年，韩国首尔三星医疗中心对775例开具SGLT-2抑制剂的心力衰竭患者进行了回顾性整理。使用Kaplan-Meier生存曲线分析SGLT-2抑制剂停药率及停药对临床结局的影响。通过Cox回归和竞争风险生存分析来分析与停药相关的因素。SGLT-2抑制剂的停药率在1年时为7.5%，5年时为20%。全身乏力、过度利尿和容量耗竭、肾功能不全进展以及尿路感染是一般医疗实践中停用SGLT-2抑制剂的主要原因。停用SGLT-2抑制剂的组比对照组有更高的心力衰竭住院率（校正风险比2.600，95%置信区间[1.233 - 5.481]，P = 0.012）。在多变量Cox回归分析中，与SGLT-2抑制剂总体停药相关的因素是女性（风险比2.478，95%置信区间[1.553 - 3.953]，P < 0.001）和较低的估计肾小球滤过率（eGFR）（每降低10 ml/min/1.73m²风险比0.884，95%置信区间[0.789 - 0.991]，P = 0.034）。停用SGLT-2抑制剂的患者心力衰竭住院风险增加，且女性和eGFR较低者的停药率更高。
