Can sodium-glucose co-transporter-2 (SGLT-2) inhibitor reduce the risk of adverse complications due to COVID-19? – Targeting hyperinflammation

Figures & data

Figure 1. Summary of reported effects of SGLT-2 inhibitors on inflammatory responses. Abbreviations. IL-1 β, interleukin 1β; IL-6, interleukin 6; MCP‐1, monocyte chemoattractant protein-1; NF‐κB, Nuclear factor κB; NLRP3, NLR family; pyrin domain-containing 3; Nox4, NADH oxidase isoform; RAS, renin-angiotensin system; TGF‐β, transforming growth factor-beta.

Table 1. Observational studies with SGLT-2 inhibitors in patients with diabetes and COVID-19.

Study	Study design	n/N	Comparator or control	Outcome measures	Findings for SGLT-2 inhibitors
Izzi-Engbeaya et al.^62	Retrospective cohort study	(24/337)	Non SGLT-2 inhibitors	Death or admission to the intensive care unit (ICU) within 30 days of diagnosis.	↓ ICU admissions and mortality (OR 0.66; 95% CI, 0.30–1.52; p = .40)
Kim et al.^61	Multi-centre observational study	(8/235)	Non SGLT-2 inhibitors	The demographic, laboratory, and radiologic findings, and the mortality, prevalence of severe disease, and duration of quarantine were compared between patients with and without DM	↓ Disease severity (OR 1.75; 95% CI, 0.23–13.50; p = .59) and mortality (OR 5.05; 95% CI, 0.48–53.26; p = .18)
Israelsen et al.^65	Retrospective cohort study	(342/1970)	GLP-1 RA (370) Or DPP-4 inhibitors (284)	Risk of hospital admission and severe outcomes	↓ Risk of hospital admission GLP-1 RA vs. SGLT-2 (OR 1.25; 95% CI, 0.87–1.79) DPP-4i vs. SGLT-2 (OR 5.05; 95% CI, 0.48–53.26)
Khunti et al.^64	Multi-centre observational study	(266,505/2,851,465)	Non-SGLT-2 inhibitors	COVID-19-related mortality	↓ COVID-19-related mortality (OR 0·82; 95% CI, 0·74–0·91)
Dalan et al.^63	Retrospective and observational cohort study	(16/76)	Non-SGLT-2 inhibitors	Hypoxia, intensive care unit (ICU) admission, mechanical ventilation, or death.	↓ Risk of mechanical ventilation (adjusted RR 0.03; 95% CI, 0.00–0.70; p = .03)

Abbreviations. n, Patients on SGLT-2 inhibitors; N, Patients with diabetes; OR, Odds ratio; HR, Hazard ratio; RR, Risk ratio; CI, Confidence interval; ICU, Intensive care unit.

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Dalan R, Ang LW, Tan WYT, et al. The association of hypertension and diabetes pharmacotherapy with COVID-19 severity and immune signatures: an observational study. Eur Heart J Cardiovasc Pharmacother. 2021;7(3):e48–e51.

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