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sotagliflozin (Zynquista)

Indications: - treatment of diabetes mellitus - adjunct therapy to insulin for diabetes mellitus type 1 - lowers HgA1c, fasting glucose, & average daily glucose levels, daily total & basal insulin dose, body weight; systolic blood pressure & diastolic blood pressure, albuminuria & hypoglycemia events [2] - may benefit patients with diabetes mellitus & acute on chronic heart failure or chronic kidney disease [3] - improves days alive & out of hospital for patients with diabetes mellitus & worsening heart failure [4] Dosage: - 200-400 mg PO QD before 1st meal of day Adverse effects: - increases risk of diabetic ketoacidosis [1,2] Mechanism of action: - inhibits SGLT1 & SGLT2 & renal tubular reabsorption of glucose Notes: - approved in the European Union to treat patients with type 1 diabetes - rejected in the U.S. by the FDA because of safety concerns [3]

Interactions

drug adverse effects of hypoglycemic agents

General

SGLT-2 inhibitor; oral glucosuric agent; flozin

Database Correlations

PUBCHEM cid=24831714

References

  1. Susman E. MedPage Today. June 24, 2018 Sotagliflozin Tx Tied to HbA1c Reductions in T1D - But instances of diabetic ketoacidosis are a concern, expert says. https://www.medpagetoday.com/meetingcoverage/ada/73675 - Buse J, et al 212-OR - Fifty-Two-Week Efficacy and Safety of Sotagliflozin, a Dual SGLT1 and SGLT2 Inhibitor, as Adjunct Therapy to Insulin in Adults with Type 1 Diabetes (inTandem1). American Diabetes Association (ADA) 2018; Abstract 212-OR
  2. Musso G, Gambino R, Cassader M, Paschetta E. Efficacy and safety of dual SGLT 1/2 inhibitor sotagliflozin in type 1 diabetes: Meta-analysis of randomised controlled trials. BMJ 2019 Apr 9; 365:l1328. PMID: 30967375 Free Article https://www.bmj.com/content/365/bmj.l1328
  3. Krumholz HN Sotagliflozin for Diabetes Patients with Worsening Heart Failure or Chronic Kidney Disease NEJM Journal Watch. Nov 16, 2020 Massachusetts Medical Society (subscription needed) http://www.jwatch.org - Bhatt DL et al. Sotagliflozin in patients with diabetes and recent worsening heart failure. N Engl J Med 2020 Nov 16; [e-pub]. PMID: 33200892 https://www.nejm.org/doi/10.1056/NEJMoa2030183 - Bhatt DL et al. Sotagliflozin in patients with diabetes and chronic kidney disease. N Engl J Med 2020 Nov 16; [e-pub]. PMID: 33200891 https://www.nejm.org/doi/10.1056/NEJMoa2030186
  4. Szarek M, Bhatt DL, Steg PG et al. Effect of sotagliflozin on total hospitalizations in patients with type 2 diabetes and worsening heart failure: A randomized trial. Ann Intern Med 2021 Jun 22; [e-pub]. PMID: 34152828 https://www.acpjournals.org/doi/10.7326/M21-0651