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URI permanente para esta coleçãohttps://repositorio.cmmg.edu.br/handle/123456789/6

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Autor: search.filters.author.Britto, Mariana Feldner deData inicial: 2022

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    Eventos adversos do uso dos inibidores de SGLT2 em pacientes com insuficiência cardíaca com fração de ejeção reduzida e preservada: revisão sistemática e meta-análise
    (Faculdade Ciências Médicas de Minas Gerais, 2023-12-14) Britto, Mariana Feldner de; Polese, Janaine Cunha; Souza, Alessandra Hubner de
    ntroduction: Heart failure (HF) is a growing public health problem, with around 64 million people affected by the disease worldwide. In recent years, a new class of drugs has emerged for the treatment of this disease with the aim of preventing the development or worsening of HF, in addition to improving quality of life. Sodium-glucose cotransporter 2 (iSGLT2) inhibitors are a class of drugs that work by decreasing glucose reabsorption, helping patients with type 2 diabetes mellitus (T2DM), but also have other beneficial effects on the body such as kidneys and heart. Despite the positive effects, there are concerns and inconsistencies in the literature about the repercussion of the use of iSGLT2 in relation to its adverse events. Objective: The present systematic review and meta-analysis aims to evaluate the occurrence of adverse events (hypotension, volume depletion, and acute kidney injury) in patients with HF with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) using iSGLT2. Method: This is a review with systematic search and meta-analysis, registered in PROSPERO (CRD42022365684) and developed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in the following databases: PubMed, EBSCO and LILACS, with no restriction of language or publication date until 2023. The following descriptors were used (Mesh): sglt2 inhibitors, heart failure, reduced ejection fraction, preserved ejection fraction, hypotension, volume depletion, acute kidney injury ("sglt2" AND "heart failure"), ("acute kidney injury AND safety"), ("hypotension AND safety"), ("volume depletion AND safety"). The selection by titles was performed by two independent examiners using Rayyan software, and then the abstracts and full titles were evaluated. The articles were included considering the acronym PICOS: (1) (P) population (adult individuals diagnosed with HFpEF or HFpEF); (2) (I) type of intervention (use of iSGLT2); (3) (C) standard therapies; (4) (O) occurrence of hypotension, volume depletion, or acute kidney injury, and (5) (S) randomized controlled trials. Two evaluators independently analyzed the risk of bias using RoB 2. The meta-analysis was performed using RevMan 3.4.1 in order to verify the effects on XIII hypotension, volume depletion, and acute kidney injury. Results: A total of 9474 records were identified, of which ten articles were included in the systematic review and meta analysis. The outcomes of hypotension, volume depletion, and acute kidney injury were assessed in isolation. In the outcome of hypotension, a statistically significant increase in risk was observed through the meta-analysis of four studies, with no heterogeneity (RR: 1.15; 95% CI 1.01 – 1.30; P=0.03; I2= 0%). Regarding volume depletion, the meta analysis including five studies showed that there was no statistically significant difference and no heterogeneity (RR: 1.12; 95% CI 1.95 – 1.33; P=0.17; I2= 0%). For acute kidney injury, based on the meta-analysis carried out with seven studies, it was observed that it was not statistically significant, presenting low heterogeneity (RR: 0.85; 95% CI 0.69 – 1.06; P=0.14; I2 = 16%). Conclusion: The present systematic review and meta-analysis showed that iSGLT2 therapy leads to a higher risk of adverse events of hypotension. No increased risk of volume depletion and acute kidney injury was observed in association with iSGLT2. Despite the 15% reduction in relative risk (not significant) in the outcome of acute kidney injury, the results suggest a renal benefit. This analysis shows us that, despite a growing number of publications in recent years involving adverse events related to the use of iSGLT2, there is still divergence of results, leading to the need for future studies with the class.