Trends of SGLT2 inhibitors among patients with and without cancer.
Authors: Sayer Michael F. , Ozaki Aya , Naqvi Ali , Chang Joseph , Lao Victor , Patel Pranav M. 
Published: September 2024

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Background:
While initial indications for SGLT2 inhibitors (SGLT2i) were for management of type 2 diabetes mellitus (DM), their use has broadened with cardiovascular and renal protective properties. Given limited studies in cancer patients, we evaluated the trends of SGLT2i usage in patients with or without cancer.
Methods:
This study is a retrospective cohort analysis that examined electronic medical records from a global health research network, TriNetX. Our study population included patients 18 and older having one of following diagnoses: heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF), chronic kidney disease (CKD), and cardiovascular disease (CVD) with DM. Cohorts were separated by cancer status, creating 8 study cohorts. The incidence of SGLT2i use was measured annually, defined as total new patients receiving an SGLT2i divided by total eligible patients for that year. Linear trend plots were created showing incidence percentage from 2016 to 2023 to compare trends in cancer patients and non-cancer patients.
Results:
Amongst all study cohorts, the observed yearly incidence of SGLT2i use was considerably lower from 2016 and 2019. Measured incidence did not exceed 2%, with no observable differences between cancer and non-cancer patients. From 2020 to 2023, the observed incidence dramatically increased year over year, doubling from the observed 2019 incidence for all groups. Differences in utilization between cancer non-cancer patient cohorts became visible from 2020 onward amongst patients with HFrEF, CKD, and DM with CVD. This is highlighted by differences in 2023 incidence percentages for HFrEF (13.1% Non-Cancer vs. 10.7% Cancer), CKD (10.0% Non-Cancer vs. 3.8% Cancer), and DM with CVD (7.6% Non-Cancer vs. 5.2% Cancer).
Conclusions:
Since 2020, there has been an uptick in SGLT2i usage across all patient cohorts, indicating increased adoption of this therapy in clinical practice. Observed incidence rates suggest that cancer patients were less likely to be prescribed SGLT2i compared to non-cancer patients. Further research is needed to understand the barriers of use and efficacy of SGLT2is in cancer patients.

Yearly incidence percentage of SGLT2 inhibitor use for 8 study cohorts represented in each column; each row represents a year where incidence is reported.

HFrEF
HFpEF
CKD
CVD + DM

Year
Non-Cancer
Cancer
Non-Cancer
Cancer
Non-Cancer
Cancer
Non-Cancer
Cancer

2016
0.27
0.32
0.28
0.41
0.31
0.37
0.88
0.8

2017
0.34
0.41
0.36
0.57
0.39
0.52
1.16
1.19

2018
0.45
0.53
0.41
0.5
0.46
0.49
1.28
1.14

2019
0.74
0.77
0.6
0.77
0.82
0.77
1.91
1.7

2020
1.55
1.31
0.83
1.02
1.52
1.04
2.77
2.07

2021
4.2
3.32
1.77
2.11
3.76
1.96
4.25
3.36

2022
8.85
7.02
4.04
3.84
7.3
2.89
5.99
4.36

2023
13.07
10.66
6.38
6.16
10
3.68
7.6
5.24

HFrEF= Heart Failure Reduced Ejection Fraction; HFpEF= Heart Failure Preserved Ejection Fraction; CKD= Chronic Kidney Disease; CVD + DM= Cardiovascular Disease with Diabetes Mellitus.