Before a drug hits the market, we evaluate its efficacy. Only if it proves effective can it be approved.
But after approval, we also examine what happens when patients stop taking it. If discontinuation leads to loss of benefits or increased mortality, it’s a clear warning: This drug is truly essential and must not be stopped casually!
Today, we’ll look at a study on drug discontinuation, focusing on two types of medications:
- Sodium-glucose cotransporter-2 (SGLT-2) inhibitors: These drugs all have “gliflozin” in their names, such as dapagliflozin and empagliflozin. For simplicity, we’ll call them “SGLT-2 inhibitors.”
- Glucagon-like peptide-1 receptor (GLP-1R) agonists: These drugs all include “peptide” in their names, like liraglutide and exenatide. We’ll refer to them as “GLP-1 agonists.”
What happens when patients stop taking them?
A discontinuation study published in the Journal of the American Society of Nephrology explored whether adverse outcomes occurred after stopping SGLT-2 inhibitors and GLP-1 agonists.
The study included adult patients with stage 3–4 kidney disease between 2005 and 2022. Among them, 96,345 were on SGLT-2 inhibitors, and 60,020 were on GLP-1 agonists.
The results showed:
- Compared to those who continued SGLT-2 inhibitors, patients who stopped had a 26% higher risk of heart failure and a 67% higher risk of death.
- Compared to those who continued GLP-1 agonists, patients who stopped had a 48% higher risk of heart failure and a 97% higher risk of death.
The consequences of stopping these drugs are severe.
So, how many kidney patients discontinued treatment?
In this study, 37% stopped SGLT-2 inhibitors, and 47% stopped GLP-1 agonists.
Why did they stop?
Well, this study didn’t exist back then—just kidding. But seriously, understanding the risks of discontinuation is key to reducing stoppage rates.
Back then, the high discontinuation rates were mainly due to two reasons:
1. Incomplete medical understanding.
As kidney function declined, doctors worried the kidneys couldn’t clear the drugs effectively.
Additionally, SGLT-2 inhibitors reduce the kidneys’ workload. But in advanced stages, when kidney function is severely compromised, doctors often stopped the drugs, reasoning: If the kidneys are failing anyway, let’s push them to work harder, even if it shortens lifespan to compensate for their inefficiency.
The kidneys, like a candle burning at both ends, are forced to overwork as they near failure.
But as medicine advances, guidelines have relaxed restrictions on SGLT-2 inhibitors, delaying discontinuation even into end-stage kidney disease. If this trend continues, we may eventually eliminate discontinuation entirely, enabling treatment at all stages.
2. Non-medical reasons.
Researchers found that even with the same condition, discontinuation rates varied by demographic. In the U.S., African and Asian populations stopped more often than white populations. Given the much higher drug prices in the U.S. compared to China, cost may be a factor.
The U.S. makes no effort to hide its wealth gap—it’s out in the open, with no intention to change. Meanwhile, China…
In any case, for these two drug classes, delaying discontinuation within safe limits leads to better kidney and heart health—and longer life!
Of course, “within safe limits” depends on individual cases, and “delaying discontinuation” requires a doctor’s judgment. Patients should never decide on their own—not only is self-assessment unreliable, but there’s also no recourse if things go wrong.
Stay compliant, stay healthy!
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