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Tolerability of SGLT2 inhibitors in patients with Fabry disease: An observational study

Isabel Mattig1,2,3,4, Berit Zirkelbach1,2, Carina Bonnekoh2

  • 1Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Charitéplatz 1, 10117, Berlin, Germany.

American Heart Journal Plus : Cardiology Research and Practice
|May 25, 2026
PubMed

Insights

Sodium glucose cotransporter 2 (SGLT2) inhibitors show an acceptable safety profile for managing heart failure (HF) in Fabry disease (FD) patients. Further research is needed to confirm their clinical benefits in this specific population.

Area of Science:

  • Cardiology
  • Nephrology
  • Genetics

Background:

  • Fabry disease (FD) commonly involves cardiac complications, including heart failure (HF).
  • Current HF management in FD follows general guideline recommendations.
  • The role of specific HF medications, like sodium glucose cotransporter 2 (SGLT2) inhibitors, in FD requires further investigation.

Purpose of the Study:

  • To investigate the use and safety of HF medications, particularly SGLT2 inhibitors, in patients with Fabry disease.
  • To analyze the impact of SGLT2 inhibitors on cardiac and renal biomarkers and echocardiographic parameters in FD patients.

Main Methods:

  • Retrospective analysis of 99 FD patients' HF medication, laboratory, and echocardiographic data.
  • Assessment of SGLT2 inhibitor use, side effects, and outcomes at baseline and follow-up.
  • Propensity score matching was employed to compare patient groups.

Main Results:

  • SGLT2 inhibitors were used in 20% of the analyzed FD cohort.
  • 15 FD patients on SGLT2 inhibitors demonstrated stable cardiac and renal biomarkers over a median follow-up of 663 days.
  • Echocardiographic parameters showed mixed trends; left ventricular ejection fraction slightly decreased in the SGLT2 inhibitor group but significantly reduced in the non-SGLT2 inhibitor group.

Conclusions:

  • SGLT2 inhibitors appear to have an acceptable safety profile in this exploratory cohort of Fabry disease patients with heart failure.
  • No clear clinical benefit of SGLT2 inhibitors could be concluded due to study limitations.
  • Further prospective studies are warranted to elucidate the efficacy and long-term outcomes of SGLT2 inhibitors in FD management.

Keywords:
Fabry diseaseHeart failureSGLT2 inhibitors

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