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. 2025 Apr 3;11(1):292-301.
doi: 10.1159/000545626. eCollection 2025 Jan-Dec.

Increasing Prescription of SGLT2 Inhibitors with Expanded Indications to the Elderly Population in Japan

Yasuhiro Oda  1 , Hiroshi Nishi  1 , Mariko Sekiguchi  1 , Motoki Odawara  1 , Masaomi Nangaku  1
Affiliations

Increasing Prescription of SGLT2 Inhibitors with Expanded Indications to the Elderly Population in Japan

Yasuhiro Oda et al. Kidney Dis (Basel). .

Abstract

Introduction: Indications for sodium-glucose cotransporter-2 (SGLT2) inhibitors have expanded to include heart failure and chronic kidney disease after the year 2020. Whether and how the demographic trends in the prescription of SGLT2 inhibitors have changed after the expansion of indications have not been studied extensively.

Methods: This study is a descriptive analysis of serial, cross-sectional data on nationwide prescription of SGLT2 inhibitors between April 2016 and March 2023 obtained from NDB Open Data Japan, which contains more than 95% of total health insurance reimbursement claims in the nation.

Results: The total number of SGLT2 inhibitor tablets prescribed in outpatient settings with prescriptions papers increased from 577,996,158 tablets in fiscal year (FY) 2020 to 904,598,175 tablets in FY 2022. Patients aged 75 years and older accounted for 20.3% of the total prescriptions in FY 2020, and this proportion increased to 27.8% in FY 2022. Among all SGLT2 inhibitors, the tablet that expanded its indications for patients with heart failure and chronic kidney disease the earliest showed the largest percentage increase in the number of prescribed tablets during this period and the highest share of the elderly population in its recipients in both sexes (men, 35.9%; women, 49.4%) in FY 2022. The number of prescribed SGLT2 inhibitor tablets per population was constantly higher in men than in women between FY 2020 and 2022, which is consistent with the sex difference in the prevalence of these diseases.

Conclusion: Prescription of SGLT2 inhibitors to the elderly population is no longer infrequent and accounts for a large portion of the entire prescription of SGLT2 inhibitors in Japan. These findings contribute to updating our perception on the demographics of SGLT2 inhibitor recipients.

Keywords: Aging; Epidemiology; NDB Open Data Japan; SGLT2 inhibitor.

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Conflict of interest statement

Y.O. is a Research Fellow of the Japan Society for the Promotion of Science; receives scholarship and research grant from the Society; and received honoraria from Kyowa Kirin and Chugai during the 3 years prior to manuscript submission. H.N. reported receiving honoraria from Astellas, AstraZeneka, MSD, Otsuka, Ono, Kyowa Kirin, Kowa, Daiichi Sankyo, Mitsubishi Tanabe, Torii, Eli Lilly, Boehringer Ingelheim, and Bayer; and research grants from Mitsubishi Tanabe, Boehringer Ingelheim, Novo Nordisk, Bayer, and Kyowa Kirin. M.S. reported receiving honoraria from Daiichi Sankyo during the 3 years prior to manuscript submission. M.N. reported receiving research funding from Kyowa Kirin, Daiichi Sankyo, Astellas, Ono, Mitsubishi Tanabe, JT, Chugai, Bayer, Torii, and Takeda; and honoraria and/or advisory fees from Kyowa Kirin, Astellas, AstraZeneca, GSK, Daiichi Sankyo, Mitsubishi Tanabe, Chugai, Torii, JT, Novo Nordisk, and Boehringer Ingelheim.

Figures

Fig. 1.
Fig. 1.
Number of sodium-glucose cotransporter-2 inhibitor tablets prescribed with prescription papers in outpatient settings in Japan. The letter m in the Y axis denotes million tablets. DPP-4i stands for dipeptidyl peptidase-4 inhibitor and forms a polypill with a sodium-glucose cotransporter-2 inhibitor. Red dotted lines indicate an approximate threshold of the number of tablets required to be listed on the NDB Open Data Japan datasets. Red box on the top of the bar for the tofogliflozin 20 mg tablet in FY 2021 shows the maximum possible number of the prescribed tablets which were discontinued by one manufacturer on March 2022 and were unlisted in the database because of the small number of prescribed tablets.
Fig. 2.
Fig. 2.
Changes in prescriptions of sodium-glucose cotransporter-2 inhibitor tablets from 2020 to 2022. Numbers of prescribed polypills are integrated to the numbers of prescribed single-ingredient pills.
Fig. 3.
Fig. 3.
Prescription of sodium-glucose cotransporter-2 inhibitors in each age. Number of prescribed tablets (a) and share of sodium-glucose cotransporter-2 inhibitor tablets (b) in each age group in FY 2022. c Number of prescribed tablets per population between FY 2020 and 2022. Tofogliflozin 20 mg tablet from one manufacturer was discontinued on March 2022 (FY 2021) and was unlisted in the database for FY 2021 because of the small number of prescribed tablets. Taking this into account, the number of total sodium-glucose cotransporter-2 inhibitor tablets prescribed in FY 2021 could be 0–1.3% higher than the number illustrated in c.
Fig. 4.
Fig. 4.
Proportion of tablets prescribed to patients aged 75 years or older. Abbreviation: DPP-4i, dipeptidyl peptidase-4 inhibitor.
Fig. 5.
Fig. 5.
Sex difference in sodium-glucose cotransporter-2 inhibitor recipients. a Number of prescribed tablets per population. The total number of tablets prescribed for patients in each age group of each sex in each FY was divided by the population of the age group and sex in the corresponding year. b Ratio of prescribed tablets for men to women. Tofogliflozin 20 mg tablet from one manufacturer was discontinued on March 2022 (FY 2021) and was unlisted in the database for FY 2021 because of the small number of prescribed tablets. Taking this into consideration, the number of total sodium-glucose cotransporter-2 inhibitor tablets prescribed in FY 2021 could be 0–1.3% higher than the number illustrated in a.
Fig. 6.
Fig. 6.
Proportion of tablets prescribed to patients aged 75 years or older in each sex. DPP-4i, dipeptidyl peptidase-4 inhibitor.
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