Discontinuation rates, clinical effects and provocation factors of SGLT-2 inhibitor in the real world

Sodium–glucose cotransporter 2 (SGLT-2) inhibitors are the only medications that improve clinical outcomes regardless of baseline left ventricular ejection fraction. Despite the recognized effectiveness of SGLT-2 inhibitors, there remains a paucity of research on the discontinuation of these medications. The objective of this study is to analyze the rate of discontinuation of SGLT-2 inhibitors, to evaluate the impact of discontinuation on the clinical outcome, and to identify the factors associated with discontinuation. From 2015 to 2021, 775 heart failure patients prescribed an SGLT-2 inhibitor were retrospectively collated at Samsung Medical Center, Seoul, Republic of Korea. The SGLT-2 inhibitor discontinuation rate and the effect of SGLT-2 inhibitor discontinuation on clinical outcome were analyzed using the Kaplan–Meier survival curve. Factors related to discontinuation were analyzed through Cox regression and competing risk survival analysis. The discontinuation rate of SGLT-2 inhibitors was 7.5% at 1 year and 20% at 5 years. General weakness, over-diuresis and volume depletion, renal dysfunction progression, and urinary tract infections are the major reasons for discontinuing SGLT-2 inhibitors in general medical practice. The group that stopped using SGLT-2 inhibitors had a higher rate of heart failure hospitalization than the control group (adjusted HR 2.600, 95% CI [1.233–5.481], P = 0.012). In multivariable Cox regression analysis, the factors associated with total SGLT-2 inhibitor discontinuation were women (HR 2.478, 95% CI [1.553–3.953], P < 0.001) and lower estimated glomerular filtration rate (eGFR) (HR 0.884 per 10 ml/min/1.73 m2, 95% CI [0.789–0.991], P = 0.034). Patients who discontinued SGLT-2 inhibitors experienced an increased risk of heart failure hospitalization, and the rate of discontinuation was higher in women and those with lower eGFR.