Comparative risk of genital infections associated with sodium‐glucose co‐transporter‐2 inhibitors

Chintan V. Dave, Sebastian Schneeweiss, Elisabetta Patorno

It is unclear the extent to which Sodium-glucose co-transporter 2 (SGLT2) inhibitors increase the risk of genital infections in routine clinical care against other antidiabetic medications, or whether the increased risk is consistent across gender or age subgroups, within individual SGLT2 agents, or it is more pronounced at a particular time after treatment initiation. We conducted a retrospective cohort study in two US commercial claims databases (2013-2017). In the primary analysis, a 1:1 propensity-score matched cohorts of female and male with type-2 diabetes mellitus initiating a SGLT2 inhibitor vs DPP-4 inhibitors was created. The outcome was a composite of genital candidal infections, vaginitis or vulvovaginitis in females, and genital candidal infections, balanitis, balanoposthitis, phimosis or paraphimosis in males. Among a propensity-score matched cohorts of 129,994 females and 156,074 males, the adjusted Hazard Ratio and excess-risk per 1,000 person years for SGLT2 v DPP-4 inhibitors was 2.81 (95% CI, 2.64, 2.99) and 87.4 (95% CI, 79.1, 96.2) respectively for females, and was 2.68 (95% CI, 2.31, 3.11and 11.9 (95% CI, 9.3-15.0) for males. Findings were similar in the SGLT2 inhibitor vs GLP1 agonist comparison, more pronounced in the subgroup of patients aged ≥60 (HR, 4.45 (95% CI, 3.83-5.17) in females and 3.30 (95% CI, 2.56-4.25) in males), and no meaningful difference across individual SGLT2 inhibitors was identified. This increase in risk was evident in the first month of treatment initiation and remained elevated throughout the course of therapy. SGLT2 inhibitors were associated with an approximately three-fold increase in risk of genital infections This article is protected by copyright. All rights reserved.