Signal Detection of Acute Renal Failure Following the Use of SGLT-2 Inhibitors: Stratified Analysis and Time Trend Analysis in Japan and the United States.

Abstract

The results of previous studies that have used databases to investigate the associations between sodium-glucose-cotransporter-2 (SGLT-2) inhibitors and acute renal failure (ARF) have differed, and the impact of biases such as the Weber effect and stimulated reporting has not been fully examined. This study aimed to determine the associations between SGLT-2 inhibitors and ARF using signal detection, the effects on signals of regulatory agency alerts for ARF, and the publication of prominent studies by measuring changes in signals over time. Data registered in the Food and Drug Administration's Adverse Event Reporting System from January 2013 to March 2020 were downloaded, signals were detected, and reporting odds ratios (RORs) were calculated for each country of occurrence (Japan/the United States). Quarterly changes in the number of reports and RORs were examined. Although an association between SGLT-2 inhibitor use and ARF was suggested in the United States, this study did not suggest such an association in Japan. The number of reports and RORs fluctuated when regulatory alerts and prominent studies were published, and events affecting the number of reports and RORs varied by country. This study revealed the difference in the associations between SGLT-2i and ARF in Japan and the United States. Additionally, the signal was identified to be influenced by alerts and the publication of studies. Therefore, these results should be interpreted cautiously as there could be a possibility of overestimation due to alert biases and publication of studies.