Tolerability of SGLT2 inhibitors in patients with Fabry disease: An observational study

Cardiac involvement of Fabry disease (FD) includes heart failure (HF) treated according to general guideline recommendations. The retrospective study investigates HF medication in FD focusing on sodium glucose cotransporter 2 (SGLT2) inhibitors. HF medication, laboratory and echocardiographic measurements as well as side effects of SGLT2 inhibitors were analyzed at baseline and the last available follow-up. The analysis included 99 FD patients treated with angiotensin converting enzyme (ACE) inhibitors or angiotensin II type 1 receptor blocker (ARB) (50%), beta-blocker (31%), SGLT2 inhibitors (20%), diuretics (12%), angiotensin receptor-neprilysin inhibitors (ARNI) (2%), and mineralocorticoid receptor antagonists (MRA) (1%). After 663 (457–725) days, 15 FD patients treated with SGLT2 inhibitors showed stable cardiac and renal biomarkers. Echocardiographic parameters did not reveal a consistent pattern: Left ventricular ejection fraction (LVEF) showed a slight decrease in the SGLT2 inhibitor group and a significant reduction in patients without SGLT2 inhibitors. Left atrial volume index (LAVI) and tricuspid annular plane systolic excursion (TAPSE) showed an upward trend in the SGLT2 inhibitor group, whereas LAVI declined and TAPSE remained unchanged in patients without SGLT2 inhibitors. After propensity score matching, there were no inter- or intragroup differences. The most common side effects comprised polyuria, hypovolemia, and vertigo. Overall, these exploratory findings suggest an acceptable safety profile of SGLT2 inhibitors in this FD cohort, without allowing clear conclusions regarding clinical benefit. • Are SGLT2 inhibitors a feasible therapeutic approach for Fabry patients with heart failure? A pilot study suggests that SGLT2 inhibitors are safe in patients with Fabry disease; however, no clear conclusions can yet be drawn regarding their clinical benefit. • Social media: Can SGLT2 inhibitors be used in Fabry disease patients with heart failure? ➔ Have a look!