ORIGINAL ARTICLE

Efficacy and Side Effect Profile of Empagliflozin and Dapagliflozin in Combination Therapy: A Real-World Experience
Empagliflozin ve Dapagliflozinin Kombinasyon Tedavisindeki Etkinliği ve Yan Etki Profilinin Değerlendirilmesi: Gerçek Yaşam Deneyimi
Received Date : 12 Apr 2021
Accepted Date : 14 Jun 2021
Available Online : 05 Jul 2021
Doi: 10.25179/tjem.2021-83764 - Makale Dili: EN
Turk J Endocrinol Metab. 2021;25:306-317
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Objective: Sodium-glucose co-transporter inhibitors (SGLT2i) offer significant cardiovascular benefits, although several adverse events have also been reported with their use. The present study aimed to determine how the preference of SGLT2i is influenced by the adverse effects and the cardiovascular and renal benefits they demonstrate in clinical practice. In addition, the effectiveness of different SGLT2i in combination therapy was revealed. Material and Methods: The patients in their third to the eighth month of SGLT2i treatment, who were admitted to our out-patient clinic for the followup evaluation of fasting plasma glucose (FPG) level, hemoglobin A1c (HbA1c) level, and body weight, were included in the present study. The follow-up evaluations were defined as those conducted at the sixth month and the final month of follow-up visits. The final-month evaluation was defined as the one conducted upon the patients’ last admission to the out-patient clinic between 10 and 14 months of the SGLT2i treatment. Results: A total of 244 patients received the SGLT2i treatment. Among the patients who fulfilled the inclusion criteria, 52 patients were in the empagliflozin group and 37 patients were in the dapagliflozin group. The FPG and HbA1c levels declined significantly in both empagliflozin (p=0.004 and p=0.002) and dapagliflozin (p=0.04, p<0.001) groups. In the combination therapy involving both the SGLT2i, the FPG and HbA1c levels decreased considerably (p<0.001). Urinary tract infection was observed as the most common complication in both empagliflozin and dapagliflozin groups. Conclusion: In Turkey, SGLT2i preference in Type 2 diabetes mellitus (T2DM) is closely associated with the data reported in the related literature. Empagliflozin and dapagliflozin, in all combinations, are, therefore, considered effective treatment options for T2DM. It is recommended to select a targeted patient population when considering the adverse effect profile as there is a trend of inconsistent follow-up in Turkey.
ÖZET
Amaç: Sodyum glukoz birlikte-taşıyıcı inhibitörleri [Sodium-glucose cotransporter inhibitors (SGLT2i)], önemli kardiyovasküler faydalarının yanında, birçok yan etkisi tanımlanmıştır. Bu çalışmada, klinik uygulamada SGLT2i tercihinin, SGLT2i’nin tanımlanmış yan etkileriyle kardiyovasküler ve renal olumlu etkilerden nasıl etkilendiğini belirlemek ve SGLT2i’nin kombinasyon tedavisindeki etkinliğini ortaya çıkarmaktır. Gereç ve Yöntemler: Çalışmaya, SGLT2i başlanması sonrası 3. ila 8. aylar arasında ayaktan poliklinik kontrolüne gelerek açlık kan şekeri (AKŞ), hemoglobin A1c (HbA1c) ve vücut ağırlığı ölçümleri yapılmış olan hastalar dâhil edildi. Takipler, 6. ay ölçümü ve son ölçüm olarak değerlendirildi. Son değerlendirme, hastaların 10-14. aylar arasında son poliklinik başvuruları olarak tanımlandı. Bulgular: Toplamda 244 hasta SGLT2i tedavisi almıştır. Çalışmaya dâhil edilme ölçütlerini karşılayan hastalardan empagliflozin grubunda 52 hasta, dapagliflozin grubunda 37 hasta bulunmaktadır. Empaglifozin ve dapagliflozin grubunda hem AKŞ hem de HbA1c değerlerinde istatistiksel olarak anlamlı düşüş saptanmıştır (sırasıyla p=0,004, p=0,002 ve p=0,04, p<0,001). Her 2 SGLT2i ile kombinasyon tedavisinde hem AKŞ hem de HbA1c değerleri anlamlı olarak düşmüştür (p<0,001). Her 2 grupta en sık görülen yan etki, idrar yolu enfeksiyonudur. Sonuç: Ülkemizde, Tip 2 diabetes mellitus (T2DM) tedavisinde SGLT2i tercihi literatürle yakın ilişkilidir. Tüm kombinasyon seçeneklerinde dapagliflozin ve empagliflozin T2DM için etkin bir tedavi seçeneğidir. Yan etki profili göz önüne alındığında, ülkemizde takip sıklığının yeterli olmaması nedeniyle tedavi verilecek hastalar dikkatle seçilmelidir.
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