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Marked erythrocytosis: 2 case reports In a series of 2 cases, a 59-year-old man and a 46-year-old man developed marked erythrocytosis during treatment with canagliflozin and empagliflozin, respectively for diabetes [routes not stated]. Patient 1: A 59-year-old man, who had diabetes since 20 years with a poor glycaemic control, had been receiving insulin glargine, gliclazide, liraglutide and metformin. He was initiated on canagliflozin 100 mg/day, and an improvement in glycaemic control was observed. However, he showed an asymptomatic increase in haemoglobin from 14.6g% (haematocrit 44.1%) before the start of canaglifozin to 18.1g% (haematocrit 54.6%) 2 years after receiving canagliflozin. He had no symptoms attributable to this increased haemoglobin. Based on the laboratory results and absence of any other risk factors, he was diagnosed with erythrocytosis secondary to canagliflozin use. He underwent therapeutic phlebotomy two times (450mL every time), and treatment with canagliflozin was discontinued. Haemoglobin was reduced to 17.3g% (haematocrit 53.3%) after phlebotomy and subsequently to 15.1g% (haematocrit 47.8) following 5 months canagliflozin cessation. Patient 2: A 46-year-old man, who had diabetes since 12 years with a good glycaemic control, had been receiving vildagliptin, metformin and multiple injections of insulin daily. To reduce body weight and insulin, he was initiated on empagliflozin 25 mg/day. However, he showed an asymptomatic increase in haemoglobin from 15.1g% (haematocrit 47.1%) before starting empagliflozin to 16.7% (haematocrit 52%) 2 years after receiving empagliflozin. His haemoglobin increased steeply to 19.7g% (haematocrit 56.1%) following 4 years of empagliflozin use. Based on the laboratory results and absence of any other risk factors, he was diagnosed with erythrocytosis secondary to empagliflozin use. Therefore, treatment with empagliflozin was discontinued, and he underwent therapeutic phlebotomy two times (450mL each time). The haemoglobin dropped to 17.3g% (haematocrit 50.8%) after phlebotomy and subsequently to 16.8g% (haematocrit 48.8%) following 1 month of stopping empaglifozin. Gupta R, et al. Marked erythrocytosis during treatment with sodium glucose cotransporter-2 inhibitors-report of two cases. Diabetes Research and Clinical Practice 162: 803499132 108127, Apr 2020. Available from: URL: http://doi.org/10.1016/j.diabres.2020.108127

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Reactions 5 Sep 2020 No. 1820