Use of SGLT2 inhibitors in pediatric heart failure: a multi-center study
Ryan Butts1, Deipanjan Nandi2, Borah Hong3
1Division of Cardiology, Department of Pediatrics, Heart Center, Children's Health, UT Southwestern Medical Center, Dallas, TX, USA. Ryan.butts@utsouthwestern.edu.
Insights
Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are used in pediatric heart failure, with common adverse events including urinary tract infections and acute kidney injury. The typical starting dose is around 0.1mg/kg/dose, but more research is needed.
Area of Science:
- Pediatric Cardiology
- Pharmacology
Background:
- Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are increasingly used in pediatric heart failure (HF).
- Limited data exists regarding optimal dosing and safety profiles in this population.
Purpose of the Study:
- To report on the dosing and adverse events associated with SGLT2 inhibitor use in pediatric heart failure.
- To analyze safety and initial dosing strategies in a diverse pediatric HF cohort.
Main Methods:
- Retrospective analysis of the ACTION pediatric heart failure registry.
- Collected data included patient demographics, HF type, SGLT2i type, dosing, adverse events, and outcomes.
Main Results:
- Data from 278 pediatric HF patients (19 institutions) using SGLT2is (dapagliflozin most common).
- Median age at initiation was 15.1 years; 32 patients discontinued SGLT2i, 15 due to intolerance.
- Most common adverse events were urinary tract infections (UTI) and acute kidney injury (AKI); typical initiation dose was 0.11 mg/kg/dose.
Conclusions:
- SGLT2 inhibitors are used in a varied pediatric HF population.
- AKI and UTI are the primary adverse events observed.
- Further prospective studies are essential to establish SGLT2 inhibitor efficacy in pediatric heart failure.
Introduction:
Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are utilized in pediatric heart failure (HF) with little data on dosing or safety profile. Our aim is to report on dosing and adverse events associated with SGLT2i use in pediatric HF.
Methods:
A retrospective study was performed utilizing the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) pediatric heart failure registry. Patient demographics, medical regimen, echocardiographic data, laboratory data, adverse events, and relevant heart failure outcomes were collected at SGLT2i initiation and last follow-up.
Results:
At time of database query, data from 278 patients from 19 institutions were common. The most common SGLT2i prescribed was dapagliflozin (244) followed by empagliflozin (34). Median age at initiation was 15.1 years (IQR 10.7-18.2), 106 had DCM, 54 had Fontan physiology, and 67% of patients were initiated in the outpatient setting. For all patients prescribed dapagliflozin, the median mg/kg/dose at initiation was 0.11 (IQR 0.08-0.14). The median follow-up was 195 days (IQR 90-450, n = 180). In the follow-up cohort, 32 patients discontinued SGLT2i with 15 due to drug intolerance. 28 patients had a total of 34 adverse events (AE) reported. The most common AE was UTI (11) followed by AKI (10). After SGLT2i initiation, 13% of patients had a subsequent HF admission, 5% had a VAD, and 9% underwent heart transplantation.
Conclusion:
In pediatric HF, SGLT2is are being utilized in a diverse patient population. AKI and UTI were the most common reported AE. Typical initiation dose is approximately 0.1mg/kg/dose. Prospective studies are needed to help determine efficacy.
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