Key result
Baseline copeptin, MR-proANP, NT-proBNP, and CRP did not predict treatment response to empagliflozin in SIAD, whereas urinary sodium >76 mmol/l predicted non-response to fluid restriction alone.
Why the study?
Empagliflozin is a promising treatment for SIAD, but biomarkers predicting treatment response to optimize success were needed.
Can baseline copeptin, natriuretic peptides, and inflammatory markers predict treatment response to empagliflozin in patients with SIAD?
RCT (n=41)
Can baseline copeptin, natriuretic peptides, and inflammatory markers predict treatment response to empagliflozin in patients with SIAD?
Baseline copeptin, natriuretic peptides, and CRP do not predict sodium response to empagliflozin in SIAD, but urinary sodium >76 mmol/l can identify patients unlikely to respond to fluid restriction alone.
Urinary sodium may guide fluid restriction decisions in SIAD; challenges predictive value of copeptin, MR-proANP, NT-proBNP, and CRP for empagliflozin response.
PURPOSE: The syndrome of inappropriate antidiuresis (SIAD) is the main cause of hyponatremia and the SGLT2-inhibitor empagliflozin is a promising new treatment option. A biomarker predicting treatment response could optimize treatment success. MATERIALS AND METHODS: = 41) with both groups receiving fluid restriction <1000 ml/d. Baseline levels of copeptin, the natriuretic peptides MR-proANP and NT-proBNP and C-reactive protein (CRP) were evaluated as predictors for treatment response defined as absolute sodium change, using linear regression models. Additionally, urinary sodium was assessed as predictor for non-response to fluid restriction alone by constructing the receiver-operating characteristic (ROC) curve. RESULTS: No clinically relevant predictive value for treatment response to empagliflozin could be found for copeptin, MR-proANP, NT-proBNP or CRP. A urinary sodium cut-off of >76 mmol/l led to a specificity of 91.7% [95% confidence interval (CI): 75%, 100%] and sensitivity of 51.9% [33.3%, 70.4%] to predict non-response to fluid restriction alone. CONCLUSIONS: : ClinicalTrials.gov (Number: NCT02874807).
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Nobbenhuis et al. (2021) conducted an RCT in Syndrome of inappropriate antidiuresis (SIAD) (n=41). Empagliflozin vs. Fluid restriction alone was evaluated on Treatment response defined as absolute sodium change. Baseline copeptin, MR-proANP, NT-proBNP, and CRP did not predict treatment response to empagliflozin in SIAD, whereas urinary sodium >76 mmol/l predicted non-response to fluid restriction alone.
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