Journal Article

Sodium–glucose cotransporter 2 inhibitor therapy reduces the administration frequency of steroid injection in patients with diabetic macular edema: A cohort study using the Japanese health insurance claims database

Inaba, Yosuke, Kawasaki, Yohei, Koshizaka, Masaya, Kawakami, Eiryo, Tatsumi, Tomoaki, Yamamoto, Shuichi, Takatsuna, Yoko, Shiko, Yuki, Yokote, Koutaro, Kashiwagi, Yusuke, Maezawa, Yoshiro, Ishibashi, Ryoichi

2024

Overview

Aims/Introduction Severe diabetic macular edema (DME) is often resistant to anti‐vascular endothelial growth factor therapy. Steroids are particularly effective at reducing edema by suppressing inflammation; they are also used as an alternative to expensive anti‐vascular endothelial growth factor therapy in some patients. Therefore, the use of steroids in DME reflects an unmet need for anti‐vascular endothelial growth factor therapy. Notably, triamcinolone acetonide (TA) injections are widely used in Japan. Here, we evaluated the frequency of TA as an indicator of the efficacy of sodium–glucose cotransporter 2 inhibitors (SGLT2is) in DME treatment using a health insurance claims database. Materials and Methods In this cohort study, we retrospectively analyzed the health insurance claims data of 11 million Japanese individuals from 2005 to 2019. The frequency and duration of TA injection after the initiation of SGLT2is or other antidiabetic drugs were analyzed. Results Among the 2,412 matched patients with DME, the incidence rate of TA injection was 63.8 times per 1,000 person‐years in SGLT2i users and 94.9 times per 1,000 person‐years in non‐users. SGLT2is reduced the risk for the first (P = 0.0024, hazard ratio 0.66, 95% confidence interval 0.50–0.87), second (P = 0.0019, hazard ratio 0.53, 95% confidence interval 0.35–0.80) and third TA (P = 0.0053, hazard ratio 0.44, 95% confidence interval 0.25–0.80) injections. A subanalysis of each baseline characteristic of the patients showed that SGLT2is were effective regardless of the background factors. Conclusions The use of SGLT2is reduced the frequency of TA injection in patients with DME. Therefore, SGLT2i therapy might be a novel, noninvasive and low‐cost adjunctive therapy for DME. This study was carried out to evaluate the frequency of triamcinolone acetonide injections as an indicator of the efficacy of sodium–glucose cotransporter 2 inhibitors in the treatment of diabetic macular edema using data from a nationwide health insurance claims database in Japan. Triamcinolone acetonide is thought to reflect some of the unmet needs of anti‐vascular endothelial growth factor therapy in diabetic macular edema, as severe diabetic macular edema is often resistant to anti‐vascular endothelial growth factor therapy, and is also used as an alternative to expensive anti‐vascular endothelial growth factor therapy in some patients. We found that the use of sodium–glucose cotransporter 2 inhibitors significantly reduced the frequency of triamcinolone acetonide injections required in this vulnerable patient group.

• Publisher: John Wiley & Sons, Inc,Wiley
• Subject: Aged / Antidiabetics / Antihypertensives / Cohort analysis / Cohort Studies / Databases, Factual / Diabetes / Diabetes mellitus / Diabetic macular edema / Diabetic Retinopathy - drug therapy / Diabetic Retinopathy - epidemiology / Diuretics / Drug use / East Asian People / Edema / Ethics / Eye diseases / Female / Follow-Up Studies / Health insurance / Hemoglobin / Human subjects / Humans / Hypertension / Injection / Insurance claims / Insurance, Health - statistics & numerical data / Japan - epidemiology / Lasers / Macular Edema - drug therapy / Macular Edema - epidemiology / Macular Edema - etiology / Male / Medical research / Metabolic disorders / Middle Aged / Patients / Regression analysis / Retrospective Studies / Side effects / Sodium-glucose cotransporter / Sodium-Glucose Transporter 2 Inhibitors - administration & dosage / Sodium-Glucose Transporter 2 Inhibitors - therapeutic use / Sodium–glucose cotransporter 2 inhibitor / Steroid hormones / Steroid injection / Steroids / Surgery / Triamcinolone acetonide / Triamcinolone Acetonide - administration & dosage / Triamcinolone Acetonide - therapeutic use / Vascular endothelial growth factor