Empagliflozin: a wonder drug for the treatment of SIAD?
Abstract
The syndrome of inappropriate antidiuresis (SIAD), the commonest cause of euvolemic hyponatremia, is associated with significant morbidity and mortality 1 2 . Despite the poor efficacy of fluid restriction 3 4 5 , second line agents, such as urea 6 7 and tolvaptan 8 9 10 , are underutilized in clinical practice. This unmet clinical need may be satisfied by empagliflozin, with emerging evidence supporting its use as a promising new treatment option for SIAD 11 12 . Empagliflozin, a potent, selective inhibitor of sodium glucose cotransporter 2 (SGLT2), is an oral glucose-lowering agent widely used for the treatment of type 2 diabetes mellitus (DM) 13 14 15 16 , especially in patients with established cardiovascular disease 17 or heart failure or chronic kidney disease (CKD) 18 because of its favorable cardiorenal outcomes. In recent years, empagliflozin has gained approval for two new indications, regardless of the presence or absence of DM; firstly, for the treatment of heart failure across the spectrum of ejection fraction 19 20 , and second, as a nephroprotective agent in patients with chronic kidney disease (CKD) at risk of progression 21 .SGLT2, a high capacity and low affinity glucose transporter located in the first segment of the proximal convoluted tubule, accounts for the reabsorption of approximately 90% of filtered glucose 22 23 . Therefore, empagliflozin, through SGLT2 inhibition, induces pronounced glycosuria, leading to osmotic diuresis and increased renal…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 88 participants or records.
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