PDF(Pubmed)
Abstract：
OBJECTIVE: Sodium glucose cotransporter 2 (SGLT2) inhibitors are a class of medications initially developed for the treatment of diabetes, although their cardiac and renal protective benefits are far reaching. There has been marked interest in the rheumatology community to adopt these medications into our clinical practice, particularly for chronic kidney disease with persistent proteinuria.
RESULTS: SGLT2 inhibitors have been approved for patients with type 2 diabetes mellitus, heart failure with reduced or preserved ejection fraction, atherosclerotic cardiovascular disease in the setting of type 2 diabetes mellitus, as well as chronic kidney disease with proteinuria. Large studies on SGLT2 inhibitors have largely excluded patients with proteinuric chronic kidney disease due to autoimmune glomerulonephritis due to concerns for confounding from immunosuppression. The Dapagliflozin and Prevention of Adverse Outcomes in CKD Trial (DAPA-CKD) showed that SGLT2 inhibition decreased progression of renal disease in patients with IgA nephropathy. Expanding this to other autoimmune glomerulonephropathies, several small studies have shown improvements in proteinuria in patients with lupus nephritis treated with SGLT2 inhibitors. A study evaluating safety of SGLT2 inhibitors in patients with lupus identified no specific concerns even with concomitant use of immunosuppression.
CONCLUSIONS: Small studies have shown that SGLT2 inhibitors can been utilized safely and efficaciously in patients with lupus nephritis. Additional research is needed to identify where these medications fit into the rheumatology treatment armamentarium.
RESULTS: SGLT2 inhibitors have been approved for patients with type 2 diabetes mellitus, heart failure with reduced or preserved ejection fraction, atherosclerotic cardiovascular disease in the setting of type 2 diabetes mellitus, as well as chronic kidney disease with proteinuria. Large studies on SGLT2 inhibitors have largely excluded patients with proteinuric chronic kidney disease due to autoimmune glomerulonephritis due to concerns for confounding from immunosuppression. The Dapagliflozin and Prevention of Adverse Outcomes in CKD Trial (DAPA-CKD) showed that SGLT2 inhibition decreased progression of renal disease in patients with IgA nephropathy. Expanding this to other autoimmune glomerulonephropathies, several small studies have shown improvements in proteinuria in patients with lupus nephritis treated with SGLT2 inhibitors. A study evaluating safety of SGLT2 inhibitors in patients with lupus identified no specific concerns even with concomitant use of immunosuppression.
CONCLUSIONS: Small studies have shown that SGLT2 inhibitors can been utilized safely and efficaciously in patients with lupus nephritis. Additional research is needed to identify where these medications fit into the rheumatology treatment armamentarium.
摘要：
目的：钠葡萄糖协同转运蛋白2（SGLT2）抑制剂是最初开发用于治疗糖尿病的一类药物，尽管它们的心脏和肾脏保护作用深远。风湿病界对将这些药物应用于我们的临床实践产生了浓厚的兴趣，特别是慢性肾脏疾病与持续性蛋白尿。
结果：SGLT2抑制剂已被批准用于2型糖尿病患者，射血分数降低或保留的心力衰竭，2型糖尿病背景下的动脉粥样硬化性心血管疾病，以及慢性肾病和蛋白尿。关于SGLT2抑制剂的大量研究已在很大程度上排除了因自身免疫性肾小球肾炎引起的蛋白尿慢性肾病患者，因为他们担心免疫抑制会造成混淆。Dapagliflozin和CKD不良结局预防试验（DAPA-CKD）显示，SGLT2抑制可降低IgA肾病患者肾脏疾病的进展。将其扩展到其他自身免疫性肾小球肾病，几项小型研究显示,SGLT2抑制剂治疗的狼疮性肾炎患者蛋白尿改善.一项评估SGLT2抑制剂在狼疮患者中的安全性的研究发现，即使伴随使用免疫抑制也没有具体问题。
结论：小型研究表明，SGLT2抑制剂可以安全有效地用于狼疮性肾炎患者。需要进一步的研究来确定这些药物适合风湿病治疗设备的位置。
结果：SGLT2抑制剂已被批准用于2型糖尿病患者，射血分数降低或保留的心力衰竭，2型糖尿病背景下的动脉粥样硬化性心血管疾病，以及慢性肾病和蛋白尿。关于SGLT2抑制剂的大量研究已在很大程度上排除了因自身免疫性肾小球肾炎引起的蛋白尿慢性肾病患者，因为他们担心免疫抑制会造成混淆。Dapagliflozin和CKD不良结局预防试验（DAPA-CKD）显示，SGLT2抑制可降低IgA肾病患者肾脏疾病的进展。将其扩展到其他自身免疫性肾小球肾病，几项小型研究显示,SGLT2抑制剂治疗的狼疮性肾炎患者蛋白尿改善.一项评估SGLT2抑制剂在狼疮患者中的安全性的研究发现，即使伴随使用免疫抑制也没有具体问题。
结论：小型研究表明，SGLT2抑制剂可以安全有效地用于狼疮性肾炎患者。需要进一步的研究来确定这些药物适合风湿病治疗设备的位置。
