2. Etsin sen kohdan , missä ja milloin tämä tauti yhdistetään ja assosioidaan SGLT2-estäjien käyttöön tai pohditaan juuri tätä kysymystä.
1.
https://www.ncbi.nlm.nih.gov/pmc/?term=fournier%27s+gangrene
2.
Toinen haku sanoilla " Fourniers gangrene, SGLT2 inhibitors": 8 vastausta.
https://www.ncbi.nlm.nih.gov/pmc/?term=fournier%27s+gangrene+%2C+SGLT2+inhibitors
2.1. Ensin selvitetään uudet hypoglykemiset lääkeryhmät:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6259591/
2.2. SGLT2-inhibiittorin käytöstä saatu tuore kokemus tältä vuodelta. Tämän siteeraan kokonaan:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6446678/
Indian J Endocrinol Metab. 2019 Jan-Feb; 23(1): 165–166.
PMCID: PMC6446678
PMID: 31016172
Fournier's Gangrene and Sodium-glucose Co-transporter 2(SGLT2) Inhibitors: Our Experience
Sir,
Recent
drug safety communication from U.S. Food and Drug Administration
reported cases of necrotizing fasciitis of the perineum - Fournier's
gangrene with sodium-glucose cotransporter-2 (SGLT2) inhibitors. Their
findings are according to the reports from FDA Adverse Event Reporting
System and case reports from medical literature from March 2013 to May
2018.[1]
We
work at 750 bedded tertiary referral hospital in South India with five
consultant endocrinologists treating on average monthly 3000 patients
through outpatient clinics of which 80% are type 2 diabetes mellitus
(T2DM).
SGLT2 inhibitor- canagliflozin was launched in
India during April 2015 followed by dapagliflozin and empagliflozin.
Since then, we have used all three SGLT2 inhibitors in our hospital
according to the recommendation of various international guidelines and
as per approved local indications. We undertook this analysis to
understand our local experience of SGLT2 inhibitors and Fournier's
gangrene.
We identified total 23 cases of Fournier's
gangrene in our hospital medical records from April 2015 to July 2018.
All cases were reported in male patients with a mean age of 56.8 ± 5.5
years. In total, 70% of cases had a history of T2DM (mean duration of 5 ±
3.2 years). The mean score of severity of Fournier's gangrene severity
index[2]
was 5.08 ± 4.6. Mean HbA1c in the cohort of T2DM patients was 10.36 ±
1.1 (range 8.6–13). None had significant medical history of chronic
liver disease. The mean serum creatinine level in people with diabetes
was 1.83 + SD mg/dl as opposed to 1.1 + SD mg/dl in people without T2DM.
All
cases required surgical intervention in form of debridement and
received intravenous antibiotics. Three patients with diabetes underwent
debridement twice during their hospital stay. Twenty-two cases had
positive wound or excised tissue culture results with streptococcus and Escherichia coli
being most common organisms. Mean hospital stay was 5 ± 3.2 days for
entire cohort, and it was 8 ± 3.3 days in the cohort with T2DM. Five
patients required additional Intensive Care Unit (ICU) stay during
hospitalization. Three patients died due to multiple organ dysfunction
associated with sepsis.
We found only one case of
Fournier's gangrene with concomitant SGLT2 inhibitor (empagliflozin)
treatment in combination with other anti-diabetic drugs. SGLT2i was
started 12 months before date of admission, HbA1C was 10.5%. The patient
was discharged after 10 days of hospital stay.
Our
experience at present does not suggest SGLT2 inhibitors as a potential
causative factor for Fournier's gangrene.
We believe that warning of
SGLT2 inhibitor and Fournier's gangrene needs to be looked from
multifactorial perspective. There can be multiple risk factor associated
with the development of Fournier's gangrene in T2DM patients such as
poor glycaemic control, genital hygiene,
recurrent fungal infection,
obesity, smoking,
urinary catherization,
operative procedures,
immunosuppressive disease or therapies, etc.[3]
The limitation of our analysis is longer and continuous follow-up of
all the patients prescribed different kind of anti-diabetic medications
and reporting bias.
Overall, as clinicians, we feel that benefits of
SGLT2 inhibitors currently outweighs risk by manifold though close
pharmaco-vigilance is warranted.
It is important for clinicians to
understand and focus on pertinent issue of controlling hyperglycemia and
reduction of micro- and macro-vascular complication with judicious and
safe use of SGLT2 inhibitors than panic and debate about Fournier's
gangrene.
2.3. Sormigangreenitapaus kuvataan. Ensimmäisen kerran assosioidaan Empaglifotsiinin käyttöön.
World J Diabetes. 2019 Feb 15; 10(2): 133–136.
Published online 2019 Feb 15. doi: 10.4239/wjd.v10.i2.133
PMCID: PMC6379730
PMID: 30788049 Bilateral gangrene of fingers in a patient on empagliflozin: First case report
Go to: Abstract
" ....
" ....
The
timing of empaglifozin and onset of symptoms as well as improvement
after stopping empaglifozin point towards a likely association of the
medication with finger gangrene.
CONCLUSION
This
first case report of empaglifozin causing finger gangrene suggests the
possibility that upper extremity gangrene with use of empaglifozin could
go undiagnosed as occurred initially in this case. Prescribers need to
be aware of this association and future studies are warranted to clarify
if upper extremity ulcers or gangrene are associated with SGLT2
inhibitor use.
Increased awareness
among primary care physicians and surgeons about this association could
prevent progression of non-healing upper extremity ulcers, gangrene and
resultant amputations."
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