Clinical experience with sodium–glucose transport 2 (SGLT2) inhibitors in patients with systemic lupus erythematosus

Objectives: Effective management of chronic kidney disease (CKD) in systemic lupus erythematosus (SLE) is crucial for reducing long-term complications. Sodium–glucose transport 2 inhibitors (SGLT2is) improve renal and cardiovascular outcomes of non-SLE-related CKD. We aimed to assess clinical characteristics and outcomes of SLE patients treated with SGLT2is. Methods: This retrospective study evaluated adult SLE patients treated with SGLT2is for ≥ 3 months compared to untreated patients. Disease-related characteristics, kidney-related factors, and comorbidities were assessed. Repeated measures analysis model was applied to compare estimated glomerular filtration rate (eGFR) at different timepoints. Additional outcomes included infections, hospitalizations, and all-cause mortality. In SGLT2is-treated patients, eGFR and albuminuria were recorded before SGLT2is initiation, at 1 month, and 1 year following SGLT2is initiation. Results: A total of 112 consecutive patients were included with a mean follow-up of 18.1 ± 12.7 years since SLE diagnosis. The use of SGLT2is in 9 SLE patients showed a stable kidney function over-time (60 ml/min/m² ± 15 before treatment vs. 60 ± 17 ml/min/m² at 1 year of treatment, p = 0.5) and a trend toward reduction in proteinuria (450 ± 637 mg/g before treatment to 279 ± 401 mg/g at 12 months following treatment, p = 0.07), without major adverse effects. No significant differences in cardiovascular events, infections, hospitalizations, or mortality rates were observed between treated and untreated patients. Conclusions: This study suggests a potential benefit of SGLT2is in SLE patients. Further research is needed to confirm the nephro- and cardioprotective effects of SGLT2is in this population.