JAMA

Does SGLT-2 inhibitor therapy improve outcomes in critically ill patients with acute organ dysfunction?

June 18, 2024

The addition of dapagliflozin to standard care for critically ill patients with acute organ dysfunction didn't improve clinical outcomes; however, confidence intervals were wide and couldn't exclude relevant benefits or harms for dapagliflozin.

• For the multicenter, open-label DEFENDER trial, patients with unplanned ICU admission presenting with at least 1 organ dysfunction (respiratory, CV, or kidney) were enrolled between November 22, 2022, and August 30, 2023, with follow-up through September 27, 2023. Participants were randomized to 10 mg of dapagliflozin (intervention, n=248) plus standard care or to standard care alone (control, n=259) for up to 14 days or until ICU discharge, whichever occurred first.
• Among 507 randomized participants (mean age, 63.9 years; 46.9%, women), 39.6% had an ICU admission due to suspected infection. Median time from ICU admission to randomization was 1 day.
• The win ratio for dapagliflozin for the primary outcome—a hierarchical composite of hospital mortality, initiation of kidney replacement therapy, and ICU length of stay through 28 days—was 1.01 (95% CI, 0.90 to 1.13; P = 0.89).
• Among secondary outcomes, the highest probability of benefit found was 0.90 for dapagliflozin regarding use of kidney replacement therapy: 10.9% in the dapagliflozin group vs. 15.1% in the control group.

Source:

Tavares CAM, et al. (2024, June 14). JAMA. Dapagliflozin for Critically Ill Patients With Acute Organ Dysfunction: The DEFENDER Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/38873723/