Use of SGLT2 inhibitors in pediatric heart failure: a multi-center study

Abstract

Introduction: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are utilized in pediatric heart failure (HF) with little data on dosing or safety profile. Our aim is to report on dosing and adverse events associated with SGLT2i use in pediatric HF.

Methods: A retrospective study was performed utilizing the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) pediatric heart failure registry. Patient demographics, medical regimen, echocardiographic data, laboratory data, adverse events, and relevant heart failure outcomes were collected at SGLT2i initiation and last follow-up.

Results: At time of database query, data from 278 patients from 19 institutions were common. The most common SGLT2i prescribed was dapagliflozin (244) followed by empagliflozin (34). Median age at initiation was 15.1 years (IQR 10.7-18.2), 106 had DCM, 54 had Fontan physiology, and 67% of patients were initiated in the outpatient setting. For all patients prescribed dapagliflozin, the median mg/kg/dose at initiation was 0.11 (IQR 0.08-0.14). The median follow-up was 195 days (IQR 90-450, n = 180). In the follow-up cohort, 32 patients discontinued SGLT2i with 15 due to drug intolerance. 28 patients had a total of 34 adverse events (AE) reported. The most common AE was UTI (11) followed by AKI (10). After SGLT2i initiation, 13% of patients had a subsequent HF admission, 5% had a VAD, and 9% underwent heart transplantation.

Conclusion: In pediatric HF, SGLT2is are being utilized in a diverse patient population. AKI and UTI were the most common reported AE. Typical initiation dose is approximately 0.1mg/kg/dose. Prospective studies are needed to help determine efficacy.

Keywords: Congenital heart disease; Pediatric heart failure; Sodium-Glucose Co-Transporter 2 inhibitors (SGLT2is); Systolic heart failure.