Sotagliflozin, sold under the brand name Inpefa among others, is a medication used to reduce the risk of death due to

heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome caused by an impairment in the heart's ability to Cardiac cycle, fill with and pump blood. Although symptoms vary based on which side of the heart is affected, HF ...

. It is an inhibitor of sodium-glucose cotransporter 1 and 2 (

SGLT1 Sodium/glucose cotransporter 1 (SGLT1) also known as solute carrier family 5 member 1 is a protein in humans that is encoded by the gene which encodes the production of the SGLT1 protein to line the absorptive cells in the small intestine and ...

SGLT2 inhibitor SGLT2 inhibitors (also called gliflozins or flozins) are a class of medications that inhibit sodium-glucose transport proteins in the nephron (the functional units of the kidney), unlike SGLT1, SGLT1 inhibitors that perform a similar function in ...

). It is taken

by mouth Oral administration is a route of administration whereby a substance is taken through the Human mouth, mouth, swallowed, and then processed via the digestive system. This is a common route of administration for many medications. Oral administ ...

. The most common adverse reactions include

urinary tract infection A urinary tract infection (UTI) is an infection that affects a part of the urinary tract. Lower urinary tract infections may involve the bladder (cystitis) or urethra (urethritis) while upper urinary tract infections affect the kidney (pyel ...

volume depletion Hypovolemia, also known as volume depletion or volume contraction, is a state of abnormally low extracellular fluid in the body. This may be due to either a loss of both salt and water or a decrease in blood volume. Hypovolemia refers to the loss ...

diarrhea Diarrhea (American English), also spelled diarrhoea or diarrhœa (British English), is the condition of having at least three loose, liquid, or watery bowel movements in a day. It often lasts for a few days and can result in dehydration d ...

, and

hypoglycemia Hypoglycemia (American English), also spelled hypoglycaemia or hypoglycæmia (British English), sometimes called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). Whipple's tria ...

. Sotagliflozin was approved for medical use in the European Union in April 2019, as Zynquista, for the treatment for

type 1 diabetes Type 1 diabetes (T1D), formerly known as juvenile diabetes, is an autoimmune disease that occurs when the body's immune system destroys pancreatic cells (beta cells). In healthy persons, beta cells produce insulin. Insulin is a hormone require ...

, and in the United States in May 2023, to reduce the risk of death due to heart failure. The marketing authorization for sotagliflozin was withdrawn in the EU in August 2022, at the request of the marketing-authorization holder. Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.

Medical uses

In the United States, sotagliflozin is

indicated In medicine, an indication is a valid reason to use a certain test, medication, procedure, or surgery. There can be multiple indications to use a procedure or medication. An indication can commonly be confused with the term diagnosis. A diagnosis ...

to reduce the risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visit in adults with heart failure; or type 2 diabetes, chronic kidney disease, and other cardiovascular risk factors.

Pharmacology

Sotaglifozin is a sodium-glucose co-transporter 1 and 2 inhibitor that reduces both postprandial glucose and insulin levels by delaying intestinal glucose absorption, decreases gastric inhibitory polypeptide, and elevations in glucagon-like peptide and peptide yy levels are consistent with local inhibition of intestinal SGLT1.

History

The US

Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respo ...

(FDA) approved sotagliflozin based on evidence from two clinical trials of 11,806 total participants with heart failure or with type 2 diabetes, chronic kidney disease, and other cardiovascular risk factors. The trials were conducted at 322 sites in 32 countries (SOLOIST/NCT03521934) and 750 sites in 42 countries (SCORED/NCT03315143) primarily in Europe, South America, and North America. Both trials were used for primary determination of the benefits and side effects of the drug. The benefits and side effects of sotagliflozin were evaluated in the two clinical trials. In both trials, participants were randomly assigned to receive either sotagliflozin or placebo by mouth once a day. Neither the participants nor the healthcare providers knew which treatment was being given until after the trial was completed. The benefit of sotagliflozin was evaluated by measuring the number of predefined events (death from cardiovascular causes, need for hospitalization for heart failure, or urgent medical care visit for heart failure) occurring in the patient population receiving sotagliflozin versus placebo.

Society and culture

Legal status

The US

(FDA) refused its approval for use in combination with

insulin Insulin (, from Latin ''insula'', 'island') is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the insulin (''INS)'' gene. It is the main Anabolism, anabolic hormone of the body. It regulates the metabol ...

for the treatment of type 1 diabetes. It is developed by Lexicon Pharmaceuticals. In May 2023, the US FDA approved sotagliflozin (Inpefa) to decrease the risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visit in adults with heart failure or type 2 diabetes, chronic kidney disease, and other cardiovascular risk. The marketing authorization for sotagliflozin was withdrawn in the EU in August 2022, at the request of the marketing-authorization holder.

Research

Combination of insulin with sotaglifozin led to a significant lowering of systolic and diastolic blood pressure and multiple indirect markers of arterial stiffness, including pulse pressure, without changes in pulse rates.