Treatment Effect of the SGLT2 Inhibitor Empagliflozin on Chronic Syndrome of Inappropriate Antidiuresis: Results of a Randomized, Double-Blind, Placebo-Controlled, Crossover Trial
Abstract
Significance Statement The syndrome of inappropriate antidiuresis (SIAD) is a major cause of hypotonic hyponatremia. Despite its prevalence, treatment options are sparse, and data on their effect on hyponatremia-associated morbidity such as neurocognitive impairment are largely lacking. New treatment options are needed. The sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin promotes osmotic diuresis via urinary glucose excretion and could be used as a treatment for chronic SIAD. This randomized, double-blind, placebo-controlled, crossover trial with 14 participants revealed that empagliflozin is well tolerated and effective compared with placebo. In addition, treatment with empagliflozin possibly led to an improvement in neurocognitive function. The results set the stage for further studies evaluating empagliflozin as a treatment option in patients with SIAD-induced hyponatremia. Background The syndrome of inappropriate antidiuresis (SIAD) is characterized by a reduction of free water excretion with consecutive hypotonic hyponatremia and is therefore challenging to treat. The sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin promotes osmotic diuresis via urinary glucose excretion, likely leading to increased electrolyte free water clearance. Methods In this randomized, double-blind, placebo-controlled, crossover trial, we compared 4-week treatment with empagliflozin 25 mg/d to placebo in outpatients with chronic SIAD-induced hyponatremia. At baseline…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 14 participants or records.
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