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PO431 IMPROVEMENT OF PSORIASIS AND CHRONIC ERUPTION AFTER TAKING SGLT2 INHIBITOR: IPRAGLIFLOZIN IN DIABETES OF JAPANESE
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Posters / Diabetes Research and Clinical Practice 106S1 (2014) S47–S267
muscle is one of the causes of insulin resistance (3). SGLT2i ameliorate hypertriglycemia and insulin resistance, which causes a reduction of TGA in muscle. Because muscli trunci is richer of TGA than musculi thoracici, the expression of SGLT2i’s effect could appear stronger in muscli trunci than in muscli thoracici, which makes the different patterns of muscle power and their change between GS and BS. In conclusion, this is a preliminary study. But the phenomena are intriguing to understand the potential mechanism of SGLT2i therapy. Grandy et al. reported the increase of quality of life who received the treatment of SGLT2i(4). The result of this study supports the phenomenon from different point of view. Therefore, further profound study is needed in practice. Reference(s) [1] Bolinder J et al. Dapagliflozin maintains glycaemic control while reducing weight and body fat mass over 2 years in patients with type 2 diabetes mellitus inadequately controlled on metformin. Diabetes Obes Metab. 2013 Aug 1. doi: 10.1111/ dom.12189. [Epub ahead of print]. [2] Cetinus E. et al. Hand grip strength in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract. 70: 278–86, 2005. [3] Man ZW et al. Decrease in triglyceride accumulation in tissues by restricted diet and improvement of diabetes in Otsuka LongEvans Tokushima fatty rats, a non-insulin-dependent diabetes model. Metabolism 49: 108–14, 2000. [4] Grandy S. et al. Changes in weight loss-related quality of life among type 2 diabetes mellitus patients treated with dapagliflozin. Diabetes Obes Metab. 2014 Jul; 16(7): 645–50.
PO431 IMPROVEMENT OF PSORIASIS AND CHRONIC ERUPTION AFTER TAKING SGLT2 INHIBITOR: IPRAGLIFLOZIN IN DIABETES OF JAPANESE Y. Suzuki1 . 1 HDC Atlas Clinic, Tokyo, Japan Background: SGLT2 inhibitor (Sodium glucose transporter 2: SGLT2i) is medication to treat diabetes, being used all over the world. The pre-release clinical trials showed that SGLT2i affect few skin complication. However, after release of ipragliflozin, SGLT2i showed high incidence of skin complications in Japanese. The summary of ipragliflozin’s adverse effect reported some severe cases. According to the condition, Japan Diabetes Society published a warning recommendation in June 2014, towards a proper usage of SGLT2i. 1) . At our clinic, seventeen patients were found who had eruption and/or itching after ipragliflozin treatment. Severe cases among them showed increased eosinophil and DLST (Drug-induced Lymphocyte Stimulation Test) was positive. Some cases noticed eruption and/or itching after taking one or two tablets of ipragliflozine. Other cases noticed the symptoms after 10–30 days of taking ipragliflozine. The true pathogenesis has not been clarified. Therefore, it was interesting to investigate the patients who demonstrate the different patterns in terms of that the effect of ipragliflozin might have beneficial effect rather than adverse effect. Method: 190 patients of type 2 diabetes were subjected. The change of skin condition was investigated every two weeks from the start of prescribing ipragliflozin. Ipragliflozin was prescribed principally 50 mg/day for all the subjects. Physicians asked carefully all the subjects by the questionnaire whether or not some beneficial event or adverse event occurred. Result: Two patients were found whose skin disorder relieved after taking ipragliflozin. Case 1: 67 y/o. man. He had suffered from psoriasis for 4 years, and was treated by steroid and anti-histamine treatment 2) . His symptoms abruptly relieved after taking ipragliflozin. The condition improved and became stable after two months. Case 2: 63 y/o. man. He had suffered three years from chronic eruption 3) . Over the years consultations with multiple dermatologists did not elicit a
diagnosis, and symptoms did not improve after numerous trials of topical corticosteroids and systemic antihistamines. But, his symptom abruptly relieved after taking ipragliflozin. The symptoms finally disappeared and he does not need topical medications. Thus, improvement of two different skin disorders was associated with taking ipragliflozin. The association in case 2 was distinct. Conclusion: The episodes indicate that skin effect of ipragliflozin is not only harmful but also beneficial among individuals. Although two cases episode is insufficient to determine the etiology and mechanism, they suggest a distinct association among ipragliflozin and skin function from a different point of view. The phenomena might give a new light in the treatment of psoriasis and chronic eruption of unknown etiology. Because psoriasis is closely associated with autoimmune diseases, ipragliflozin might have an intra-skintissue effect possibly associated with immunologic factors 4) . Reference(s) [1] Japan Diabetes Society: Recommendation from “Committee on the proper use of SGLT2 inhibitors” (in Japanese) http:/ / www.jds.or.jp / modules / important / index.php?page= article& storyid=48 [2] Di Meglio P, Villanova F, Nestle FO. Psoriasis. Cold Spring Harb Perspect Med. 2014; 4. pii: a015354. doi: 10.1101 / cshperspect.a015354. [3] Convers KD1, Sturm JM, Slavin RG. Chronic bilateral pruritic arm dermatitis in a 61-year-old woman. Allergy Asthma Proc. 2013; 34: 558–61. [4] Wu JJ, Nguyen TU, Poon KY, Herrinton LJ. The association of psoriasis with autoimmune diseases. J Am Acad Dermatol. 2012; 67: 924–30.
PO432 HIGH OCCURRENCE OF BALANITIS AS AN ADVERSE EFFECT CAUSED BY SGLT2 INHIBITORS IS FREQUENTLY FOUND IN THE YOUNG GENERATIONS BELOW 50 YEARS OF OLD Y. Suzuki1 . 1 Diabetes department, HDC Atlas Clinic, Tokyo, Japan Background: SGLT2i (sodium-glucose transporter 2 inhibitors) has been used in Japan since April, 2014. Four products of SGLTi have been released and widely prescribed. One is ipragliflozin, and the others are dapagliflozin, luseogliflozin, and tofogliflozin. In common, genital infection was thought to be common in the elderly. However, practically, the question what kind of patients are likely to be affected regarding balanitis has not been clarified. Therefore, we reported the adverse effect of balanitis through closed SNS service, called as TmDance, and also gathered the official drug information from eight pharmaceutical companies. Method: About 200 patients of type 2 diabetes were subjected at our HDC Atlas Clinic. They were equally out-patients. Their complaints were questioned and each of adverse effect was reported through TmDance (closed SNS service). TmDance is one of social medical network system, which composed of closed and secret communication system between medical doctors and medical representatives independently. Medical doctor reported adverse effects soon after he noticed the adverse effect by using copy&paste from electronic chart to the dairy of TmDance. Through TmDance, medical representitives of pharmaceutical companies promptly noticed and could gather the adverse effect information as soon as possible. In addition, by making use of TmDance, the occurrence of adverse effect, especially regarding balanitis, was collected from medical representatives. Data of adverse effect in Japan, especially of balanitis, were based on the description of drug information which has been reported every month from eight pharmaceutical companies. Result: According to the database of drug information, in ipargliflozin, totally 22 patients of balanitis were reported (< 50 y/o: 12, 50–59 y/o: 4, 60–69 y/o: 3, 70 yo: 3). In
Posters / Diabetes Research and Clinical Practice 106S1 (2014) S47–S267
muscle is one of the causes of insulin resistance (3). SGLT2i ameliorate hypertriglycemia and insulin resistance, which causes a reduction of TGA in muscle. Because muscli trunci is richer of TGA than musculi thoracici, the expression of SGLT2i’s effect could appear stronger in muscli trunci than in muscli thoracici, which makes the different patterns of muscle power and their change between GS and BS. In conclusion, this is a preliminary study. But the phenomena are intriguing to understand the potential mechanism of SGLT2i therapy. Grandy et al. reported the increase of quality of life who received the treatment of SGLT2i(4). The result of this study supports the phenomenon from different point of view. Therefore, further profound study is needed in practice. Reference(s) [1] Bolinder J et al. Dapagliflozin maintains glycaemic control while reducing weight and body fat mass over 2 years in patients with type 2 diabetes mellitus inadequately controlled on metformin. Diabetes Obes Metab. 2013 Aug 1. doi: 10.1111/ dom.12189. [Epub ahead of print]. [2] Cetinus E. et al. Hand grip strength in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract. 70: 278–86, 2005. [3] Man ZW et al. Decrease in triglyceride accumulation in tissues by restricted diet and improvement of diabetes in Otsuka LongEvans Tokushima fatty rats, a non-insulin-dependent diabetes model. Metabolism 49: 108–14, 2000. [4] Grandy S. et al. Changes in weight loss-related quality of life among type 2 diabetes mellitus patients treated with dapagliflozin. Diabetes Obes Metab. 2014 Jul; 16(7): 645–50.
PO431 IMPROVEMENT OF PSORIASIS AND CHRONIC ERUPTION AFTER TAKING SGLT2 INHIBITOR: IPRAGLIFLOZIN IN DIABETES OF JAPANESE Y. Suzuki1 . 1 HDC Atlas Clinic, Tokyo, Japan Background: SGLT2 inhibitor (Sodium glucose transporter 2: SGLT2i) is medication to treat diabetes, being used all over the world. The pre-release clinical trials showed that SGLT2i affect few skin complication. However, after release of ipragliflozin, SGLT2i showed high incidence of skin complications in Japanese. The summary of ipragliflozin’s adverse effect reported some severe cases. According to the condition, Japan Diabetes Society published a warning recommendation in June 2014, towards a proper usage of SGLT2i. 1) . At our clinic, seventeen patients were found who had eruption and/or itching after ipragliflozin treatment. Severe cases among them showed increased eosinophil and DLST (Drug-induced Lymphocyte Stimulation Test) was positive. Some cases noticed eruption and/or itching after taking one or two tablets of ipragliflozine. Other cases noticed the symptoms after 10–30 days of taking ipragliflozine. The true pathogenesis has not been clarified. Therefore, it was interesting to investigate the patients who demonstrate the different patterns in terms of that the effect of ipragliflozin might have beneficial effect rather than adverse effect. Method: 190 patients of type 2 diabetes were subjected. The change of skin condition was investigated every two weeks from the start of prescribing ipragliflozin. Ipragliflozin was prescribed principally 50 mg/day for all the subjects. Physicians asked carefully all the subjects by the questionnaire whether or not some beneficial event or adverse event occurred. Result: Two patients were found whose skin disorder relieved after taking ipragliflozin. Case 1: 67 y/o. man. He had suffered from psoriasis for 4 years, and was treated by steroid and anti-histamine treatment 2) . His symptoms abruptly relieved after taking ipragliflozin. The condition improved and became stable after two months. Case 2: 63 y/o. man. He had suffered three years from chronic eruption 3) . Over the years consultations with multiple dermatologists did not elicit a
diagnosis, and symptoms did not improve after numerous trials of topical corticosteroids and systemic antihistamines. But, his symptom abruptly relieved after taking ipragliflozin. The symptoms finally disappeared and he does not need topical medications. Thus, improvement of two different skin disorders was associated with taking ipragliflozin. The association in case 2 was distinct. Conclusion: The episodes indicate that skin effect of ipragliflozin is not only harmful but also beneficial among individuals. Although two cases episode is insufficient to determine the etiology and mechanism, they suggest a distinct association among ipragliflozin and skin function from a different point of view. The phenomena might give a new light in the treatment of psoriasis and chronic eruption of unknown etiology. Because psoriasis is closely associated with autoimmune diseases, ipragliflozin might have an intra-skintissue effect possibly associated with immunologic factors 4) . Reference(s) [1] Japan Diabetes Society: Recommendation from “Committee on the proper use of SGLT2 inhibitors” (in Japanese) http:/ / www.jds.or.jp / modules / important / index.php?page= article& storyid=48 [2] Di Meglio P, Villanova F, Nestle FO. Psoriasis. Cold Spring Harb Perspect Med. 2014; 4. pii: a015354. doi: 10.1101 / cshperspect.a015354. [3] Convers KD1, Sturm JM, Slavin RG. Chronic bilateral pruritic arm dermatitis in a 61-year-old woman. Allergy Asthma Proc. 2013; 34: 558–61. [4] Wu JJ, Nguyen TU, Poon KY, Herrinton LJ. The association of psoriasis with autoimmune diseases. J Am Acad Dermatol. 2012; 67: 924–30.
PO432 HIGH OCCURRENCE OF BALANITIS AS AN ADVERSE EFFECT CAUSED BY SGLT2 INHIBITORS IS FREQUENTLY FOUND IN THE YOUNG GENERATIONS BELOW 50 YEARS OF OLD Y. Suzuki1 . 1 Diabetes department, HDC Atlas Clinic, Tokyo, Japan Background: SGLT2i (sodium-glucose transporter 2 inhibitors) has been used in Japan since April, 2014. Four products of SGLTi have been released and widely prescribed. One is ipragliflozin, and the others are dapagliflozin, luseogliflozin, and tofogliflozin. In common, genital infection was thought to be common in the elderly. However, practically, the question what kind of patients are likely to be affected regarding balanitis has not been clarified. Therefore, we reported the adverse effect of balanitis through closed SNS service, called as TmDance, and also gathered the official drug information from eight pharmaceutical companies. Method: About 200 patients of type 2 diabetes were subjected at our HDC Atlas Clinic. They were equally out-patients. Their complaints were questioned and each of adverse effect was reported through TmDance (closed SNS service). TmDance is one of social medical network system, which composed of closed and secret communication system between medical doctors and medical representatives independently. Medical doctor reported adverse effects soon after he noticed the adverse effect by using copy&paste from electronic chart to the dairy of TmDance. Through TmDance, medical representitives of pharmaceutical companies promptly noticed and could gather the adverse effect information as soon as possible. In addition, by making use of TmDance, the occurrence of adverse effect, especially regarding balanitis, was collected from medical representatives. Data of adverse effect in Japan, especially of balanitis, were based on the description of drug information which has been reported every month from eight pharmaceutical companies. Result: According to the database of drug information, in ipargliflozin, totally 22 patients of balanitis were reported (< 50 y/o: 12, 50–59 y/o: 4, 60–69 y/o: 3, 70 yo: 3). In