Completed Research: CLINICAL/TRANSLATIONAL RESEARCH
Abstract #CR19

Urinary Tract Infections in Patients Receiving Chemotherapy and SGLT2 Inhibitors

JHOP - March 2023 Vol 13 Special Feature - HOPA Abstracts

Presenters: John Bossaer, PharmD, BCOP, East Tennessee State University Bill Gatton College of Pharmacy, Johnson City, TN; Rachel Rikard, PharmD, University of North Carolina Medical Center, Chapel Hill, NC

BACKGROUND: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are associated with an increased risk for urinary tract infections (UTIs). The incidence of UTIs in pivotal trials is up to 9.3% in the general population. Immunosuppressing chemotherapy makes patients more susceptible to infection, causing further concern for getting UTIs with SGLT2 inhibitors. A single trial has been published suggesting that there is not an increased risk for UTIs in patients who have a solid-organ transplant and are receiving SGLT2 inhibitors while using immunosuppressants. However, the risk for a UTI while receiving an SGLT2 inhibitor and chemotherapy is unknown.

OBJECTIVE: To describe the incidence of UTIs in patients receiving concomitant SGLT2 inhibitors and chemotherapy.

METHOD: The medical records of patients receiving immunosuppressive or myelosuppressive chemotherapy (ie, cytotoxic agents, rituximab, CDK4/6 inhibitors) who also received an SGLT2 inhibitor listed as a home medication in outpatient cancer clinic electronic health records were retrospectively reviewed. The study population included patients with encounters at 2 rural cancer centers between November 1, 2020, and November 1, 2021. The primary outcome was the incidence of UTIs among the study population. The secondary outcomes were to compare SGLT2 inhibitor agents and analyze other UTI risk factors.

RESULTS: A total of 540 patients were screened, and 46 patients were included in the study. The majority of screening failures were a result of a lack of cancer treatment or the concomitant use of an SGLT2 inhibitor while receiving treatment. Of the 46 patients, 10 (21.7%) had a UTI (95% confidence interval, 9.8-33.6). This included 8 patients who were receiving empagliflozin and 2 patients who were receiving dapagliflozin. The majority (N = 10) of patients who had a UTI had a solid-tumor malignancy (N = 8) and received chemotherapy alone (N = 6).

CONCLUSION: This small, retrospective study suggests that there may be an increase in UTI risk in patients concomitantly taking SGLT2 inhibitors and chemotherapy compared with the general population. Given the high number of screening failures, research collaborators from other cancer centers are needed to provide a more robust analysis of the UTI risk in this patient population.

  1. Zinman B, Wanner C, Lachin JM, Fitchett D, et al; EMPA-REG OUTCOME Investigators. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373:2117-2128.
  2. Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al; DAPA-CKD Trial Committees and Investigators. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020;383:1436-1446.
  3. Neal B, Perkovic V, Mahaffey KW, et al; CANVAS Program Collaborative Group. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377:644-657.
  4. Halden TAS, Kvitne KE, Midtvedt K, et al. Efficacy and safety of empagliflozin in renal transplant recipients with posttransplant diabetes mellitus. Diabetes Care. 2019;42:1067-1074.
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