Abstract 5: Fournier Gangrene Associated with SGLT-2 Inhibitors

Bersoff-Matcha, Susan J., et al. "Fournier Gangrene Associated With Sodium–Glucose Cotransporter-2 Inhibitors: A Review of Spontaneous Postmarketing Cases." Annals of internal medicine 170.11 (2019): 764-769.

SUMMARY

• This article was to discuss case report of Fournier Gangrene (FG) in adult diabetic patients who were taking SGLT2 inhibitors compared to other antiglycemic agents. They searched the FDA Adverse Event Reporting System database to find the cases. They also searched a number of electronic databases to identify case series, case reports and epidemiologic studies. This search strategy was used for other standard-of-care antiglycemic agents from other drug classes to act as a comparison group.

• They found 55 unique cases of FG in patients on SGLT2 inhibitors. All of the patients were severely ill and required surgical debridement. This compared to 19 FG cases associated with other antiglycemic agents. 

PMID: 31060053

EDITOR'S COMMENTARY - Ken Milne, MD
There is a trend to under-report adverse events in post-marketing surveillance. While this type of study does not establish causation between SGLT2 inhibitors and FG is should raise some concern. 

BOTTOM LINE: Fournier gangrene is a rare and serious infection and we should consider this association with SGLT2 inhibitors when prescribing anti-glycemic drugs.