Introduction Randomised controlled trials show a reduction in acute kidney injury, renal impairment, and acute renal failure after initiation of a sodium glucose cotransporter-2 inhibitor. Observational literature on the association is conflicting, however important to understand for populations with a higher risk of medication-related adverse renal events. We aimed to systematically review the literature to summarize the association between sodium glucose cotransporter-2 inhibitor use and acute kidney injury, renal impairment, and acute renal failure in three at-risk groups: older people aged >65 years, people with heart failure, and people with reduced renal function. Methods Data Sources: A systematic search of Embase (1974–29/03/21) and PubMed (1946–29/03/21) was performed. Study Selection: RCTs and observational studies were included if they reported numbers of acute kidney injury or acute renal failure in people using sodium glucose cotransporter-2 inhibitors, compared to other diabetic therapies. Studies needed to report results by level of renal function, heart failure status, or age. Results Of 858 results, 6 studies were included. The absolute risk of acute kidney injury or acute renal failure was higher in people >65 years compared to those <65 years, higher in people with heart failure (vs. without), and higher in people with reduced kidney function (vs. preserved kidney function), but insufficient evidence to determine if the relative effect of sodium glucose cotransporter-2 inhibitors on this risk was similar for each group. Conclusion At risk cohorts are associated with a higher incidence of acute kidney problems in users of sodium glucose cotransporter-2 inhibitors.

Background: Long-term changes in medication dispensings post cystic fibrosis transmembrane conductance regulator (CFTR) modulator initiation have not been described. We investigated changes in dispensings among people with Cystic Fibrosis (PwCF) following modulator initiation, using national prescription claims data in Australia. Methods: Using a 10% sample of the Australian Pharmaceutical Benefits Scheme (PBS) data between 2013-2022, linear regression was used to analyse dispensings in PwCF who initiated any modulator (cases) and matched PwCF controls not dispensed a modulator. The difference in mean number of total monthly dispensings pre- and post-modulator initiation was analysed, with separate analyses by medication class. Results: A total of 247 cases were matched 1:1 to controls (case and control median age 21 years (IQR: 13-32), 55.1% male). Immediately after modulator initiation, the mean number of dispensings was 0.9 higher in the modulator group, but then decreased to the level of controls after approximately 5 years. After 7.5 years, cases had decreased opioids compared to the pre-modulator period (β-coefficient: -0.00131, 95% CI: -0.00164, -0.00097) whilst controls did not (β: -0.00014, 95% CI: -0.00042, 0.00014). Over the same time period controls had an increase in psychotropics (β: 0.00389, 95% CI:0.00295, 0.00484) whilst cases remained stable (β: -0.00014, 95% CI: -0.0006, 0.00031). Women’s health medications increased in cases (β:0.00026, 95% CI:0.0001, 0.00042) but decreased in controls (β:-0.00044, 95% CI:-0.00063, -0.00025). Conclusions: Modulator initiation in PwCF was associated with decreased dispensings of opioids and psychotropics, and increased dispensings of women’s health medications, suggesting improved patient outcomes across multiple clinical domains .

The COVID-19 pandemic has disrupted seeking and delivery of healthcare. Different Australian jurisdictions implemented different COVID-19 restrictions. We used Australian national pharmacy dispensing data to conduct interrupted time series analyses to examine the incidence and prevalence of opioid dispensing in different jurisdictions. Following nationwide COVID-19 restrictions, the opioid incidence dropped by -0.40 [-0.50, -0.31], -0.33 [-0.46, -0.21] and -0.21 [-0.37, -0.04] /1000 people/week and prevalence dropped by -0.85 [-1.39, -0.31], -0.54 [-1.01, -0.07] and -0.62 [-0.99, -0.25] /1000 people/week in Victoria, New South Wales and other jurisdictions, respectively. Incidence and prevalence increased by 0.29 [0.13, 0.44] and 0.72 [0.11, 1.33] /1000 people/week, respectively in Victoria post-lockdown; no significant changes were observed in other jurisdictions. No significant changes were observed in the initiation of long-term opioid use in any jurisdictions. More stringent restrictions coincided with more pronounced reductions in overall opioid initiation, but initiation of long-term opioid use did not change.