Pan-tumor propensity-matched analysis of association of SGLT2 inhibitor use with clinical outcomes in patients receiving immune checkpoint inhibitors

Recently, SGLT2 inhibitors have emerged as a treatment option for type 2 diabetes mellitus (T2D) and have also shown promising antitumor activity in preclinical models. A retrospective multicenter matched cohort analysis evaluated the association of SGLT2 inhibitor use with clinical outcomes in patients receiving immune checkpoint inhibitors (ICIs). The analysis, using the Epic Cosmos database, included patients with T2DM and/or congestive heart failure and an advanced solid tumor treated with ICIs. Ten differen solid tumor types, eleven ICIs, and three SGLT2 inhibitors were analyzed. In the propensity-matched analysis, 573 patients received SGLT2 inhibitor plus ICIs (‘exposure group’) and 573 received ICIs alone (‘control group’). Compared with patients in the control group, those in the exposure group had improved median overall survival (mOS; 27.4 versus 17.4 months; HR 0.68; p<0.001). When stratified by histology, significant improvements in mOS were seen for non-small cell lung cancer and renal cell carcinoma patients. Survival benefit was attenuated when accounting for immortal time bias in late initiators of SLGT2 inhibitors, though persisted among patients prescribed SGLT2 inhibitors at or prior to initiation of ICIs. Patients in the exposure group experienced longer time on immunotherapy compared to patients in the control group. The authors conclude that patients prescribed SGLT2 inhibitors at or prior to ICI initation had a modest improvement in survival compared to patients treated with ICIs alone.