SUN-155 Clinical Experience of SGLT2 Inhibitors in a Hispanic Population: Should We Consider Its Use as Add-On Treatment?

Introduction: 1 in 11 adults have DM globally,¹ and Hispanics have higher complication rates.² A study determined that ~$16,750/year are spent by patients in medical related costs, of which ~$9,600 are related to diabetes.³ Half of Type 2 Diabetes Mellitus (T2DM) patients aren't achieving HbA1C targets,⁴ uncovering the need for treatment intensification. The primary purpose of this study was to assess the mean reduction in HbA1C between T2DM patients treated with SGLT2 inhibitors (SGLT2I) as adjunct therapy versus patients using other treatments not including SGLT2I. METHOD: T2DM patients with HbA1C > 7 (n=130) were selected for this retrospective cohort study; 69 SGLT2I users and 61 SGLT2I non-users. Medical records were reviewed and demographics, treatment received, HbA1C and side effects were evaluated during a 6-month follow-up period. RESULTS: The average baseline HbA1C for patients using vs not using SGLT2I as add-on was similar with a mean difference of 0.225 [CI -0.41-0.86], p<0.486. The mean difference in HbA1C at 6 months follow-up between both groups was -1.06 [95%CI: -1.70, -0.42], p<0.001. Adjusting for confounders resulted in a regression coefficient of -1.07 [95%CI: -1.85, -0.29], p<0.008, the null hypothesis was rejected and it was concluded that the use of SGLT2I is responsible for the increased HbA1C in the treatment group. CONCLUSION: Puerto Rico is under an economic crisis that affects patients treatment warranted by the availability of some medications due to affordability as supported by Roglic et al.⁵ The present study depicts a higher A1C reduction in patients using SGLT2 inhibitors as adjunctive treatment. But should we consider it as add-on treatment of T2DM? We may say that if patients are able to bear the expense of SGLT2I and/or are close to target it may be used as adjunctive treatment since the mean difference in A1C between both groups was -1.07 at 6 months. Limitations were the short follow up duration and a small population using SGLT2I due to high medication costs. REFERENCES: 1. Zheng Y, et al. (2017) Global Aetiology and Epidemiology of T2DM and its Complications. Nat Rev Endocrinol, 14(2), 88-98. 2. Hazel L, et al. (2015) Racial/Ethnic and Gender Differences in Severity of Diabetes-Related Complications, Health Care Resource Use, and Costs in a Medicare Population. Popul Health Manag, 18(2), 115-22. 3. Campos C. (2007) Addressing Cultural Barriers to the Successful Use of Insulin in Hispanics With T2 Diabetes. South Med J, 100(8), 812- 20. 4. Ali M, et al. (2013) Achievement of Goals in U.S. Diabetes Care, 1999-2010. N Engl J Med, 368(17), 1613-24. 5. Roglic G, et al. (2018) Medicines for Treatment Intensification in T2 Diabetes and Type of Insulin in T1 and T2 Diabetes in Low-Resourse Settings: Synopsis of the WHO on Second and Third Line Medicines and Type of Insulin for the Control of Blood Glucose Levels in Nonpregnant Adults With DM. Ann Intern Med, 169(6), 394-97.

In Vitro Dissolution as a Tool for Formulation Selection: Telmisartan Two-Step IVIVC

The purpose of this investigation was to develop an exploratory two-step level A IVIVC for three telmisartan oral immediate release formulations, the reference product Micardis, and two generic formulations (X1 and X2). Correlation was validated with a third test formulation, Y1. Experimental solubility and permeability data were obtained to confirm that telmisartan is a class II compound under the Biopharmaceutic Classification System. Bioequivalence (BE) studies plasma profiles were combined using a previously published reference scaling procedure. X2 demonstrated in vivo BE, while X1 and Y1 failed to show BE due to the lower boundary of the 90% confidence interval for C_max being outside the acceptance limits. Average plasma profiles were deconvoluted by the Loo-Riegelman method to obtain the oral fractions absorbed ( f_a). Fractions dissolved ( f_diss) were obtained in several conditions in USP II and USP IV apparatus, and later, the results were compared in order to find the most biopredictive model, calculating the f₂ similarity factor. The apparatus and conditions showing the same rank order than in vivo data were selected for further refinement of conditions. A Levy plot was constructed to estimate the time scaling factor and to make both processes, dissolution and absorption, superimposable. The in vitro dissolution experiment that reflected more accurately the in vivo behavior of the different formulations of telmisartan employed the USP IV dissolution apparatus and a dissolution environment with a flow rate of 8 mL/min and a three-step pH change, from 1.2 to 4.5 and 6.8, with a 0.05% of Tween 80. Thus, these conditions gave rise to a biopredictive dissolution test. This new model is able to predict the formulation differences in dissolution that were previously observed in vivo, which could be used as a risk-analysis tool for formulation selection in future bioequivalence trials.

Increased urinary CD80 excretion and podocyturia in Fabry disease

BACKGROUND

Certain glomerulopathies are associated with increased levels of CD80 (B7-1). We measured the urinary excretion of CD80, podocyturia and proteinuria in controls and in subjects with Fabry disease either untreated or on enzyme replacement therapy (ERT).

METHODS

Cross-sectional study including 65 individuals: controls (n = 20) and Fabry patients (n = 45, 23 of them not on ERT and 22 on ERT). Variables included age, gender, urinary protein/creatinine ratio (UPCR), estimated glomerular filtration rate (eGFR), urinary uCD80/creatinine ratio (uCD80) and podocyturia. CD80 mRNA expression in response to lyso-Gb3, a bioactive glycolipid accumulated in Fabry disease, was studied in cultured human podocytes.

RESULTS

Controls and Fabry patients did not differ in age, eGFR and gender. However, UPCR, uCD80 and podocyturia were significantly higher in Fabry patients than in controls. As expected, Fabry patients not on ERT were younger and a higher percentage were females. Non-ERT Fabry patients had less advanced kidney disease than ERT Fabry patients: UPCR was lower and eGFR higher, but uCD80 and podocyturia did not differ between non-ERT or ERT Fabry patients. There was a significant correlation between uCD80 and UPCR in the whole population (r 0.44, p 0.0005) and in Fabry patients (r 0.42, p 0.0046). Lyso-Gb3 at concentrations found in the circulation of Fabry patients increased uCD80 expression in cultured podocytes.

CONCLUSIONS

Fabry disease is characterized by early occurrence of increased uCD80 excretion that appears to be a consequence of glycolipid accumulation. The potential for uCD80 excretion to reflect early, subclinical renal Fabry involvement should be further studied.