"Is sotagliflozin a 'wonder drug'? A review of its impact on cardiovascular, diabetic, renal, neuroprotective, and hepatic outcomes".

Abstract

Heart failure (HF) and diabetes mellitus frequently co-occur, with an incidence of HF among diabetics ranging from 9% to 22%. Clinical research underscores that shared pathophysiological pathways link these conditions, driving advancements in therapeutic strategies that target neuro-hormonal modulation and sodium-glucose co-transporter 2 (SGLT2) inhibition. The SOLOIST-WHF and SCORED trials highlighted the efficacy of sotagliflozin, a dual sodium-glucose co-transporters 1/2 (SGLT1/2) inhibitor, in patients with HF and chronic kidney disease (CKD), demonstrating reductions in cardiovascular mortality and HF-related hospitalizations. Trials with other SGLT2 inhibitors, like dapagliflozin and empagliflozin, in HF, diabetes, and renal disease also showed significant reductions in major adverse cardiovascular events, hospitalizations, and improved kidney function. Furthermore, SGLT2 inhibitors have shown neuroprotective effects, potentially benefiting patients with Alzheimer's and Parkinson's diseases. Dual SGLT1/2 inhibitors, by targeting glucose transport in the renal and intestinal systems, not only reduce blood glucose but also improve insulin sensitivity, weight loss, and cardiovascular health. Sotagliflozin specifically impacts postprandial glucose absorption, mitigating the risks of hypoglycemia and hyperglycemia-related complications. In diabetic CKD, SGLT inhibitors promote renal protection by reducing glucose reabsorption, diuresis, and systemic inflammation. Neuroprotective effects of these agents, including reduced oxidative stress and inflammatory markers, show promise in treating neurodegenerative diseases. While adverse effects like hypoglycemia and ketoacidosis remain concerns, tailored dosing, and monitoring strategies may mitigate these risks. Thus, SGLT inhibitors, especially dual inhibitors like sotagliflozin, offer broad therapeutic benefits in diabetes, HF, CKD, and potentially neurological conditions.