{"title":"Dapagliflozin for rheumatic musculoskeletal disease in patients with chronic kidney disease.","authors":"Hironari Hanaoka, Jun Kikuchi, Kazuoto Hiramoto, Mitsuhiro Akiyama, Shutaro Saito, Yasushi Kondo, Tatsuhiko Azegami, Yuko Kaneko","doi":"10.1093/mr/roae090","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To elucidate the effectiveness of dapagliflozin, a sodium-glucose cotransporter 2 (SGLT-2) inhibitor, on renal function in patients with rheumatic musculoskeletal diseases complicated by chronic kidney disease (CKD) and identify factors associated with the response to dapagliflozin.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients with rheumatic musculoskeletal disease and CKD who were treated with dapagliflozin for more than a year. The good response was defined as an improvement in the estimated glomerular filtration rate (eGFR) slope per year after dapagliflozin treatment compared to that before treatment. Additionally, we investigated the response rate and its predictive factors.</p><p><strong>Results: </strong>In this analysis, 43 patients were included. The average eGFR slope demonstrated a significant improvement after dapagliflozin treatment compared to that before the treatment (0.04 vs -0.55 mL/min/1.73m²/year, p=0.001). A good response rate was 69.8% and was associated with low average levels of C-reactive protein, a high frequency of angiotensin II receptor blocker (ARB) use, and a low frequency of tacrolimus use compared to non-response (0.08 ± 0.18 vs 0.25 ± 0.29 mg/dL, p=0.03; 80.0% vs 38.4%, p=0.01; 10.0% vs 76.9%, p<0.01).</p><p><strong>Conclusion: </strong>Dapagliflozin is effective for rheumatic musculoskeletal diseases patients with CKD for preventing deterioration of renal function. Antihypertensive treatment with ARBs and inflammation control without tacrolimus was associated with a high likelihood of favorable response to dapagliflozin.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Modern Rheumatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/mr/roae090","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
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Abstract
Objective: To elucidate the effectiveness of dapagliflozin, a sodium-glucose cotransporter 2 (SGLT-2) inhibitor, on renal function in patients with rheumatic musculoskeletal diseases complicated by chronic kidney disease (CKD) and identify factors associated with the response to dapagliflozin.
Methods: We conducted a retrospective analysis of patients with rheumatic musculoskeletal disease and CKD who were treated with dapagliflozin for more than a year. The good response was defined as an improvement in the estimated glomerular filtration rate (eGFR) slope per year after dapagliflozin treatment compared to that before treatment. Additionally, we investigated the response rate and its predictive factors.
Results: In this analysis, 43 patients were included. The average eGFR slope demonstrated a significant improvement after dapagliflozin treatment compared to that before the treatment (0.04 vs -0.55 mL/min/1.73m²/year, p=0.001). A good response rate was 69.8% and was associated with low average levels of C-reactive protein, a high frequency of angiotensin II receptor blocker (ARB) use, and a low frequency of tacrolimus use compared to non-response (0.08 ± 0.18 vs 0.25 ± 0.29 mg/dL, p=0.03; 80.0% vs 38.4%, p=0.01; 10.0% vs 76.9%, p<0.01).
Conclusion: Dapagliflozin is effective for rheumatic musculoskeletal diseases patients with CKD for preventing deterioration of renal function. Antihypertensive treatment with ARBs and inflammation control without tacrolimus was associated with a high likelihood of favorable response to dapagliflozin.
目的阐明钠-葡萄糖共转运体2（SGLT-2）抑制剂达帕格列净对并发慢性肾脏病（CKD）的风湿性肌肉骨骼疾病患者肾功能的疗效，并确定与达帕格列净反应相关的因素：我们对接受达帕格列净治疗一年以上的风湿性肌肉骨骼疾病合并慢性肾脏病患者进行了回顾性分析。与治疗前相比，达帕格列净治疗后每年估计肾小球滤过率（eGFR）斜率的改善即为良好反应。此外，我们还研究了应答率及其预测因素：本分析共纳入 43 例患者。与治疗前相比，达帕格列净治疗后的平均 eGFR 斜率有显著改善（0.04 vs -0.55 mL/min/1.73m²/year, p=0.001）。良好应答率为69.8%，与无应答相比，良好应答率与C反应蛋白平均水平低、血管紧张素II受体阻滞剂（ARB）使用频率高和他克莫司使用频率低有关（0.08 ± 0.18 vs 0.25 ± 0.29 mg/dL，p=0.03；80.0% vs 38.4%，p=0.01；10.0% vs 76.9%，p结论：达帕格列净对患有慢性肾脏病的风湿性肌肉骨骼疾病患者有效，可防止肾功能恶化。使用ARBs进行降压治疗和不使用他克莫司进行炎症控制与达帕格列非洛嗪获得良好反应的可能性很高相关。
期刊介绍：
Modern Rheumatology publishes original papers in English on research pertinent to rheumatology and associated areas such as pathology, physiology, clinical immunology, microbiology, biochemistry, experimental animal models, pharmacology, and orthopedic surgery.
Occasional reviews of topics which may be of wide interest to the readership will be accepted. In addition, concise papers of special scientific importance that represent definitive and original studies will be considered.
Modern Rheumatology is currently indexed in Science Citation Index Expanded (SciSearch), Journal Citation Reports/Science Edition, PubMed/Medline, SCOPUS, EMBASE, Chemical Abstracts Service (CAS), Google Scholar, EBSCO, CSA, Academic OneFile, Current Abstracts, Elsevier Biobase, Gale, Health Reference Center Academic, OCLC, SCImago, Summon by Serial Solutions
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