Canagliflozin vs Placebo in Type 2 Diabetes for CV and Renal Events

Achal Patel, Mercer University College of Pharmacy

Type 2 diabetes (T2D) is the more common form of diabetes mellitus compared to type 1 diabetes (T1D) and accounts for ~90% of all diabetes patients. [1] Complications of diabetes include cardiovascular, macrovascular, microvascular, peripheral nerve, and renal diseases. Evidence shows that use of SGLT2 inhibitors may help in reducing the risk of cardiovascular complications, albuminuria, and renal diseases. [2]

Canagliflozin (Invokana®), is a sodium-glucose cotransporter 2 (SGLT2) inhibitor that lowers the renal threshold for glucose and increases urinary glucose excretion by interfering with the reabsorption of renally-filtered glucose across the tubular lumen of the proximal renal tubules. [3] Sodium-glucose cotransporter 2 inhibitors are the most recent type of diabetic agents approved for T2D management in the U.S. Previously, the Food and Drug Administration published a guidance for industry that new diabetic agents should be assessed for their cardiovascular safety. [2] The article below summarizes two canagliflozin trials that assessed its effect on CV risks (CANVAS) and albuminuria (CANVAS-R).

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Canagliflozin Effect on Cardiovascular and Renal Events in Type 2 Diabetes

Kishan Patel, Mercer University College of Pharmacy

Canagliflozin is a sodium-glucose cotransporter 2 (SGLT-2) inhibitor that allows for lower blood glucose in patients with type 2 diabetes (T2D) by increasing the urinary excretion of glucose. [1] There is a large amount of data that suggests T2D is an independent risk factor for cardiovascular disease.  Furthermore, cardiovascular disease is also the cause of death for the majority of patients with T2D. [2] Current evidence suggests that canagliflozin may be more effective than comparative options such as dipeptidyl peptidase-4 (DPP-4) inhibitors in lowering glycated hemoglobin (HbA1C), body weight, and blood pressure when used as an add-on therapy with metformin. Canagliflozin also appears to be superior when used in combination with metformin than sulfonylureas (SU) in regard to lowering body weight, blood pressure, and risk of hypoglycemia. However, direct evidence from comparative studies is only limited to sitagliptan (DPP-4 inhibitor) and glimepiride (SU) for their respective drug classes.  Therefore, conclusions for canagliflozin’s comparative effectiveness against other agents in the same class as DPP-4 inhibitors and sulfonylureas have been deduced from indirect evidence in network meta-analyses. [3] Continue reading