Sodium glucose co-transporter-2 (SGLT2) inhibitors do not lead to lower 28-day all-cause mortality compared with usual care or placebo in patients hospitalized with COVID-19, according to late-breaking research presented in a Hot Line session today at ESC Congress 2023.
Treatments targeting COVID-19 pathobiology such as dysregulated immune responses, endothelial damage, microvascular thrombosis, and inflammation have been shown to improve the key outcomes in this patient group. SGLT2 inhibitors, which modulate similar pathobiology, provide cardiovascular protection and prevent the progression of kidney disease in patients at risk of these events , and may also lead to organ protection in a setting of acute illness, such as COVID-19.
The meta-analysis evaluated the effects of SGLT2 inhibitors compared with usual care or placebo on 28-day all-cause mortality and other efficacy endpoints in patients hospitalised with COVID-19. The primary safety outcome was ketoacidosis by 28 days. Trials were identified through systematic searches of clinicaltrials.gov, EudraCT, and the ISRCTN registry between November 2022 and January 2023.
By 28 days after randomization, there were 351 deaths among 3,025 patients randomized to SGLT2 inhibitors and 382 deaths among 3,071 patients randomized to usual care or placebo. The summary odds ratio was 0.93 for SGLT2 inhibitors, with consistency across trials. This corresponded to an absolute mortality risk of 11.7% for SGLT2 inhibitors compared with an assumed mortality risk of 12.4% for usual care or placebo.
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