Safety and Efficacy of SGLT2 Inhibitors in ANCA-Associated Vasculitis

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) have demonstrated profound cardioprotective and renal protective benefits in large clinical trials, which have thus far excluded patients with vasculitis. ANCA-associated vasculitis (AAV) is associated with higher mortality than the general population, with cardiovascular risk and chronic kidney disease (CKD) remaining independent risk factors. Methods: We conducted a retrospective study of patients with AAV who started an SGLT-2 inhibitor at a single academic centre between 2021 and 2024. Inclusion criteria included a diagnosis of AAV and initiation of an SGLT-2i. Clinical and treatment data were extracted from the electronic medical record. The primary outcomes were complications related to SGLT-2i and AAV relapses. Secondary outcomes included proteinuria reduction and decline in eGFR. Results: Ten patients were included in this analysis, with a mean age of 61 years; 60% were male, with 70% having MPO positivity. Indication for SGLT-2i was predominantly heart failure with or without a diagnosis of CKD in 50%, with the remainder being CKD and diabetes. All patients were on active immunosuppressive therapy and in remission upon initiation of SGLT-2i (Fig-1) At a mean follow-up of 2.5 years, no complications related to SGLT-2i required discontinuation of medication, and 1 out of 10 patients had a relapse of AAV. Proteinuria and eGFR remained stable during the entire follow-up period. Conclusion: Our study demonstrated a good safety profile of SGLT-2i in AAV patients that has previously not been reported. It warrants additional study for its strong nephroprotective profile in AAV patients.