SFEBES2025 Poster Presentations Endocrine Cancer and Late Effects (9 abstracts)
The use of empagliflozin for paraneoplastic siadh: observations from a real-world cohort treated at a tertiary oncology centre
Amit Singh 1 , Maria Michaelidou 1 , Laura Cove-Smith 1 , Shaishav Dhage 1 , Tim Cooksley 1 , Jan Hoong Ho 1 & Safwaan Adam 1,2
1The Christie Hospital, Manchester, United Kingdom; 2The University of Manchester, Manchester, United Kingdom
Paraneoplastic syndrome of inappropriate antidiuretic hormone (pSIADH) is common and increases cancer-related morbidity. In addition to anti-cancer therapy, the usual management of pSIADH includes fluid restriction and pharmacotherapy with demeclocycline or vasopressin receptor antagonists. These measures show variable effectiveness, require intense monitoring, and can cause serious toxicity. Previous studies have demonstrated the efficacy of the sodium-glucose cotransporter-2 inhibitor empagliflozin in managing patients with SIADH. We report our experience of empagliflozin use specifically in patients with pSIADH due to metastatic cancer at The Christie Hospital, a tertiary oncology centre in North-West England. Fifteen patients with pSIADH attending our acute oncology unit were commenced on empaglifozin between September 2023 and August 2024. Baseline characteristics, indication, and response to treatment are described in Table 1. One patient reported nocturia as a side-effect, however there were no episodes of ketoacidosis or urinary tract infections recorded in our cohort. Despite the small cohort, our findings indicate a potential role for empagliflozin in managing pSIADH. Further research is needed to corroborate our observations.
| Variable Number/Finding Comments | ||
| Sex | ||
| Male | 0 | |
| Female | 7 | |
| Primary Malignancy | ||
| Small-cell lung | 10 | |
| Non-small-cell lung | 1 | |
| Prostate | 2 | |
| Vulval | 1 | |
| Lymphoma | 1 | |
| Baseline Sodium (mmol/l) | ||
| Median (min-max range) | 119 (116-126) | |
| Indication for treatment | ||
| Suboptimal/poor response to other measures | ||
| Tolvaptan | 1 | |
| Demeclocycline | 3 | |
| Fluid Restriction alone | 3 | |
| Hyperglycaemia +SIADH | 3 | |
| Side-effects | 1 | |
| Cautions/contra-indications with other agents | ||
| Dose | 7 | |
| 10 mg | 7 | |
| 25 mg | 8 | |
| Sustained improvement in sodium to >125 mmol/L | ||
| 1 week | 13/15 | |
| 1 month | 8/11 | 13/15 died due to progressive cancer. |
| 3 months | 7/9 | 1 stopped empagliflozin (after 6-months) due to resolution of pSIADH |
| 6 months | 4/5 | |
| 9 mont7/hs | 2/2 | |
| 12 months | 1/1 | |
| Median Sodium in mmol/L (min-max range) | ||
| 1 week | 127 (116-138) | |
| 1 month | 131 (118-139) | |
| 3 months | 130 (114-141) | |
| 6 months | 133 (122-142) |
Volume 109
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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