Gangrena de Fourniere más frecuente con inhibidores de SGLT-2

Diabetes Drug Class Associated with Fournier Gangrene

By Amy Orciari Herman

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are associated with increased risk for Fournier gangrene, according to an FDA analysis published in the Annals of Internal Medicine. The agency first issued a warning about the potential association in 2018.

In the 6 years after SGLT2 inhibitors were first approved, some 55 cases of Fournier gangrene were reported in treated patients. Diagnostic criteria included necrotizing infection of the perineum plus surgical debridement. In contrast, just 19 cases were reported over 35 years in patients taking other diabetes drugs.

Here are some details of the cases associated with SGLT2 inhibitors:

• Roughly 70% were in men.
• The time from treatment initiation to Fournier gangrene ranged from 5 days to 49 months.
• Complications included diabetic ketoacidosis, sepsis, and kidney injury.
• Eight patients underwent fecal diversion surgery, and two patients developed necrotizing fasciitis of a lower extremity that led to amputation.
• Three patients died.

The researchers conclude that clinicians "should be aware of this possible complication and have a high index of suspicion to recognize it in its early stages."

Why We Chose This as Our Top Story

William E. Chavey, MD, MS: SGLT2 inhibitors as a class have received favorable press recently owing to their benefit with regard to incidence of heart failure, cardiovascular disease, and diabetic nephropathy. We already know that at least one agent in this class has a boxed warning for amputation. This study will necessitate further caution when considering this class of drugs.

André Sofair, MD, MPH: The important thing with Fournier gangrene is to recognize it early on. As the authors clearly state, we should all have a higher index of suspicion for this possible complication in patients on these medications.

Annals of Internal Medicine article (Free abstract)

Background: Physician's First Watch coverage of 2018 FDA warning(Free)

Sent from my iPhone

Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

Please excuse the shortness of this message, as it has been sent from
a mobile device.