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In combined results from two studies, lower-extremity amputations (mostly toe or metatarsal level) were significantly more common with the sodium-glucose cotransporter-2 (SGLT-2) inhibitor canagliflozin (Invokana) than with placebo (6.3 vs. 3.4 amputations per 1000 patient-years; NEJM JW Gen Med Aug 1 2017 and N Engl J Med 2017; 377:644). This outcome resulted in a black box warning in the drug's prescribing information. Now, in this retrospective cohort study, researchers used a U.S. commercial drug-prescribing database to determine whether use of SGLT-2 inhibitors was associated with excess risk for amputations. Data were available for about 40,000 new users of SGLT-2 inhibitors for an average of 4 months.
In adjusted analyses, SGLT-2 inhi…