SGLT2 Inhibitors Linked to Higher Survival Rate in Patients With T2D and CRC

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) were associated with improved survival outcomes in patients with type 2 diabetes (T2D) and colorectal cancer (CRC), researchers reported in the Journal of Gastroenterology and Hepatology.

The retrospective cohort study was conducted at 2 tertiary medical centers among adults with T2D who were diagnosed and treated with CRC. SGLT2i recipients and SGLT2i nonrecipients were matched for age, sex, and cancer stage.

Primary efficacy outcomes were overall survival (OS) and progression-free survival (PFS), and primary safety outcomes were serious adverse events.

A total of 184 patients (median age, 68 [IQR, 62-73] years; men, 66%) were included — 92 patients were in the non-SGLT2i cohort and 92 were in the SGLT2i cohort. The median follow-up was 29.0 (IQR, 15.8-42.3) months in the SGLT2i group and 36.6 (IQR, 11.9-57.6) months in the non-SGLT2i group.

Patients treated with SGLT2i had an increased 5-year OS (86.2%; 95% CI, 72.0%-93.5% vs 62.3%; 95% CI, 50.9%-71.8%; log-rank, P =.013) and PFS (76.6%; 95% CI, 60.7%-86.7% vs 57.0%; 95% CI, 46.2%-66.4%; log-rank, P =.021) compared with those who did not receive SGLT2i.

The univariate Cox proportional analysis showed that use of SGLT2i was associated with a 64% decrease in all-cause mortality (HR, 0.36; 95% CI, 0.15-0.84; P =.018) and a 53% decrease in disease progression (HR, 0.47; 95% CI, 0.24-0.90; P =.024). After adjustment for age, sex, cancer stage, cancer treatment, and comorbidities, SGLT2i use was associated with a statistically significant decrease in all-cause mortality and disease progression and remained associated with lower all-cause mortality and disease progression after adjustment for HbA1c levels.

In a sensitivity analysis, patients treated with SGLT2i had an increased 5-year OS (86.2%; 95% CI, 72.0%-93.5% vs 59.4%; 95% CI, 31.5%-79.0%; log-rank, P =.019) and PFS (76.6%; 95% CI, 60.7%-86.7% vs 60.1%; 95% CI, 37.8%-76.7%; log-rank, P =.035) compared with those who had a noninsulin and non-SGLT2i diabetes regimen. SGLT2i use was associated with a 68% decrease in all-cause mortality (HR, 0.32; 95% CI, 0.11-0.88; P =.027) and a 58% decrease in disease progression (HR, 0.42; 95% CI, 0.18-0.97; P =.041) in univariate Cox proportional analysis, with comparable trends observed in multivariate Cox proportional analyses and time-varying Cox proportional analyses.

SGLT2i use was not associated with a higher risk for sepsis (HR, 1.52; 95% CI, 0.51-4.58; P =.46), hypoglycemia (HR, 0.63; 95% CI, 0.11-3.47; P =.60), or acute kidney injury (HR, 3.06; 95% CI, 0.51-18.5; P =.22).

Limitations include the retrospective, nonrandomized design, small sample size, and likely residual confounders between the SGLT2i and non-SGLT2i groups. Also, the researchers were unable to determine specific indications of SGLT2i prescriptions, and patients treated with insulin were included as part of the control group. Furthermore, the findings were based on use of dapagliflozin, canagliflozin, and empagliflozin.

“We found that blockade of SGLT2 using SGLT2i was associated with an improvement in both OS and PFS in patients with T2DM and colorectal adenocarcinoma,” study authors noted. “Importantly, SGLT2i were not associated with an increased risk of serious adverse events.”

This article originally appeared on Gastroenterology Advisor