Mp26-19 the Potential Role of Sodium/Glucose Cotransporter 2 (Sglt2) Inhibitors in the Treatment of Cystinuria

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy (MP26)1 May 2024MP26-19 THE POTENTIAL ROLE OF SODIUM/GLUCOSE COTRANSPORTER 2 (SGLT2) INHIBITORS IN THE TREATMENT OF CYSTINURIA Wilson Sui, Heiko Yang, Manoj Desai, Thomas Chi, and Marshall Stoller Wilson SuiWilson Sui , Heiko YangHeiko Yang , Manoj DesaiManoj Desai , Thomas ChiThomas Chi , and Marshall StollerMarshall Stoller View All Author Informationhttps://doi.org/10.1097/01.JU.0001009408.66023.77.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Disrupting the disulfide bond of the dimer, cystine, using thiol-containing medications has historically been the standard pharmacologic strategy for patients with cystinuria. Despite these medications, frustratingly high stone recurrence rates are commonplace. The Maillard reaction, which is a non-enzymatic reaction that requires heating between an amino acid and carbohydrate. We hypothesized that continuous washing of cystine stones with glucose could theoretically prevent growth of an existing cystine stone or even reduce its size. Sodium/Glucose Cotransporter 2 (SGLT2) inhibitors, well known for inducing glucosuria, were used to test this hypothesis in an initial series of patients. METHODS: Patients with cystinuria from September 2019 to May 2023 who received off-label dapaglifozin (Farxiga™) were identified. Patients who were on thiols or other clinical trial medications were taken off the medication for at least 30 days prior to starting dapaglifozin. Demographic information, past medical history, medication information and stone-related measures were extracted. A symptomatic stone event was defined by stone passage or surgical intervention. RESULTS: Ten cystinuric patients were prescribed SGLT2 inhibitors with a median follow up of 13.5 months. Each patients' historic stone event rate was tallied and compared to the event rate while prescribed SGLT2 medication. Overall, 80% of patients experienced fewer or equivalent stone events and half had stable stone volume during therapy. 24-hour urine collections revealed a significantly higher citrate excretion while on the medication (719mg±254 vs 1172mg±649, paired T-test p=0.03). Eight patients had negative cystine capacity at baseline, yet seven experienced fewer stone events while on medication: four experienced no stone growth. One patient was taken off the SGLT2 inhibitor due to an adverse reaction; three others experienced mild, self-resolving effects and yet stayed on the medication. CONCLUSIONS: Cystinuric patients treated with a SGLT2 inhibitor experienced fewer stone events while on medication compared to their historic rates and also exhibited decreased or stable stone growth. There were few medication related side effects, almost all of which were temporary. SGLT2 inhibitors may be a promising long-term therapy for patients with cystinuria. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e421 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Wilson Sui More articles by this author Heiko Yang More articles by this author Manoj Desai More articles by this author Thomas Chi More articles by this author Marshall Stoller More articles by this author Expand All Advertisement PDF downloadLoading ...