Cardiovascular outcomes of sodium glucose co-transporter-2 inhibitor treatment in cancer patients receiving anthracycline chemotherapy: a systematic review and meta-analysis

Abstract Background Anthracycline-induced cardiac dysfunction is an unwanted complication of anticancer therapy with treatment including conventional heart failure medications. Recent observational and experimental studies have shown cardioprotective effects of sodium-glucose cotransporter-2 inhibitor (SGLT2i) in cancer patients receiving chemotherapy. Due to the wide applicability of this drug as Class I treatment in all spectrums of heart failure, SGLT2i can therefore be a promising subject of investigation for its effects in cancer patients with anthracycline-induced cardiac dysfunction. Methods Observational studies and randomized controlled studies were searched but only observational studies were found. Adult diabetic patients 18 years old and above receiving anthracycline-based chemotherapy were included. Primary outcomes include hospitalization due to heart failure and development of new onset heart failure, while the secondary outcome is the all-cause mortality. Pooled odd ratios with 95% confidence intervals were used as effect estimates with fixed-effects model. Results Four observational studies were included with a total of 5,457 patients. There was a significant reduction in hospitalizations from heart failure in the SGLT2 inhibitor group compared with the group without SGLT2i (OR 0.47, CI 0.38-0.59, p 0.00001). There is a significant decline in all-cause mortality in the SGLT2 inhibitor group (OR 0.37, CI 0.29-0.47, p 0.00001). Conclusion SGLT2 inhibitors may provide significant risk reduction in heart failure hospitalizations, all-cause mortality, and heart failure exacerbation in cancer patients treated with anthracycline.