Abstract:Objective To conduct a comprehensive analysis on the reproductive toxicity of sodium-glucose co-transporter 2 (SGLT2) inhibitors and to uncover the potential signals based on the US Food and Drug Administration Adverse Event Reporting System (FAERS), hoping to provide references for rational clinical drug use. Methods We selected the data from the first quarter of 2013 to the second quarter of 2021 in FAERS to conduct disproportionality analysis. Two approaches, based on statistical shrinkage transform, reported odds ratio (ROR) and information component (IC), were used to evaluate the correlation between SGLT2 inhibitors and reproductive adverse events (AEs). Based on the important medical event (IME) list, we screened the IMEs of reproduction. The definition of AEs and IMEs relied on the preferred terms by the Medical Dictionary for Regulatory Activities (MedDRA) version 24.0. The clinical characteristics of patients, prognosis, signal detection results and time to onset (TTO) for specified AEs were analyzed. Results A total of 2 700 records of reproductive AEs were associated with SGLT2 inhibitors, with "primary suspect" and "secondary suspect" used as filters. In general, males were more prone to reproductive AEs, with a much higher proportion than females (57.59%[1 555/2 700]vs 35.70%[964/2 700]). Monotherapy (IC025:1.40; ROR025:2.65) was associated with a higher strength of reproductive AEs than the combination (IC025:1.21; ROR025:2.37). In monotherapy, a total of 56 signals were detected, with 8 strong signals and 13 IMEs. The common reproductive AEs included Fournier's gangrene, genital infection fungal, and balanoposthitis. There were 10 IMEs which were not mentioned in the instructions, including male external genital cellulitis, breast cancer, and penile cancer. Conclusion In addition to the known reproductive AEs, there remain other important reproductive signals of SGLT2 inhibitors. The reproductive toxicity varies among SGLT2 inhibitors, and clinicians should be reminded to fully consider the risk-benefit balance and prioritize IMEs for surveillance.