新規抗高血糖薬関連の体重減少に伴う末梢神経合併症：コホート研究

Weight loss can cause or exacerbate peripheral nerve disorders, including peripheral neuropathy and entrapments. Novel antihyperglycaemic agents, including glucagon-like peptide-1 receptor (GLP1R) agonists and sodium-glucose co-transporter 2 (SGLT2) inhibitors, may cause weight loss in addition to their effects on glucose levels.

Retrospective cohort review from 2020 to 2024 of adult patients undergoing electrodiagnostic evaluation for suspected peripheral nerve dysfunction. Cases were included if there was clinical and/or electrodiagnostic confirmation of peripheral nerve disorder with temporal association (onset < 12 months) to use of GLP1R agonists, SGLT2 inhibitors, or dipeptidyl peptidase-4 inhibitors.

Five cases are described (78 M with femoral and fibular neuropathy, 58 F with fibular neuropathy, 85 M with fibular neuropathy, 48 M with median nerve entrapments and sensory peripheral neuropathy, 45 M with median and ulnar nerve entrapments and sensory peripheral neuropathy) all temporally associated with weight loss and use of GLP1R agonists or SGLT2 inhibitors.

Neuropathy may develop following rapid weight loss or normalization of hyperglycaemia during treatment with GLP1R agonists or SGLT2 inhibitors. The underlying pathogenesis is unclear, but is unlikely due to direct effect of these medications on peripheral nerves. Caution is recommended and further work to establish safe targets for HbA1c and weight loss is needed.