ECE2019 Oral Communications Anterior and Posterior pituitary 2 (5 abstracts)
Empagliflozin increases sodium-levels in patients with the syndrome of inappropriate antidiuretic hormone secretion – a randomized, double-blind, placebo-controlled trial
Julie Refardt 1, , Cornelia Imber 1, , Clara O Sailer 1, , Nica Jeanloz 1, , Laura Potasso 1, , Alexander Kutz 1, , Andrea Widmer 1 , Sandrine Urwyler 1, , Fahim Ebrahimi 1, , Deborah R Vogt 3 , Bettina Winzeler 1, & Mirjam Christ-Crain 1,
1Departments of Endocrinology, Diabetology and Metabolism University Hospital Basel, Basel, Switzerland; 2University of Basel, Basel, Switzerland; 3Clinical Trial Unit, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland.
Introduction: The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the predominant cause of hyponatremia but the available treatment options are unsatisfying and often of little efficiency. The selective sodium-glucose co-transporter 2 inhibitor empagliflozin promotes osmotic diuresis due to glucosuria and might be a novel treatment option for SIADH.
Material and methods: From September 2016 through December 2018 we randomly assigned 88 hospitalized patients with hyponatremia below 130 mmol/l due to SIADH to receive either 25 mg of empagliflozin or placebo once daily in addition to standard fluid restriction. The primary endpoint was defined as absolute change in plasma sodium concentration after four days of treatment.
Results: In total, 84 patients completed the trial of whom 40 (48%) received treatment with empagliflozin and 44 (52%) were allocated to placebo. There were no significant between-group differences among main baseline characteristics, showing an elderly study population with a median age of 80 years (IQR 65–84) in the empagliflozin and 78 years (IQR 73–85) in the placebo group. Baseline median plasma sodium concentrations were 126 mmol/l (IQR 122–127) and 126 mmol/l (IQR 123–127), respectively. The most common cause of SIADH was drug-induced. Treatment with empagliflozin resulted in a significantly higher increase of median plasma sodium concentration of 10 mmol/l (IQR 5–13) compared to placebo with 7 mmol/l (IQR 3–11), P=0.039. Sodium overcorrection, defined as an increase of more than 12 mmol/l per day, occurred in one patient per group.
Conclusion: In patients with SIADH, empagliflozin in addition to fluid restriction leads to a higher increase in plasma sodium levels compared to placebo and therefore is a promising new treatment option.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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