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Canagliflozin demonstrates positive impact on certain cardiac biomarkers
Canagliflozin, a sodium-glucose cotransporter 2 inhibitor, mitigated the rise in two cardiac biomarkers in older patients with type 2 diabetes, researchers reported in the Journal of the American College of Cardiology.
The study examined the effects of canagliflozin (Invokana, Janssen Pharmaceuticals) on changes in serum N-terminal pro-B-type natriuretic peptide, high-sensitivity troponin I (hsTnI ), soluble ST2 and galectin-3.
The researchers randomly assigned 666 patients aged 55 to 80 years with type 2 diabetes to receive canagliflozin 100 mg or 300 mg (n = 450; mean age, 64 years; 55% men) or placebo (n = 216; mean age, 63 years; 62% men). Biomarker levels were assessed at baseline, 26 weeks, 52 weeks and 104 weeks.
Serum NT-proBNP and hsTnI levels rose during the study period for the placebo group but not for the canagliflozin group, James L. Januzzi Jr., MD, from the department of medicine, division of cardiology, Massachusetts General Hospital and Harvard Medical School, and colleagues wrote.
The difference in median percent change in NT-proBNP as determined by Hodges-Lehmann estimates between canagliflozin and placebo was –15% at 26 weeks, –16.1% at 52 weeks and –26.8% at 104 weeks, whereas the difference in median percent change in hsTnI as determined by Hodges-Lehmann estimates was –8.3% at 26 weeks, –11.9% at 52 weeks and –10% at 104 weeks (P < .05 for all).
Serum ST2 levels did not change in either group after 104 weeks. Serum galectin-3 levels increased in the canagliflozin group compared with the placebo group at 26 weeks (6.6%; P < .01) and 52 weeks (5.1%; P < .01), but not at 104 weeks (3%; P = .11), according to the researchers.
“The effects on NT-proBNP and hsTnI seen with canagliflozin vs. placebo in this post hoc analysis are compatible with attenuation in [CV] risk in those treated with SGLT2 inhibitors,” Januzzi and colleagues wrote.
In a related editorial, Nikolaus Marx, MD, from the department of internal medicine at University Hospital Aachen, Germany, wrote that, “These data may certainly pave the way for future research with a focus on prevention of CVD and [HF] development in diabetes and, as such, stimulate further studies to explain more precisely the effects seen in EMPA-REG OUTCOME and Integrated CANVAS Program CV outcome trials.” – by Erik Swain
Disclosures: Januzzi reports financial ties with Abbott, AbbVie, Amgen, Boehringer Ingelheim, Janssen, Novartis, Pfizer, Philips, Prevencio, Roche Diagnostics, Siemens and Singulex. Marx reports financial ties with AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Merck Sharpe & Dohme, Novo Nordisk and Sanofi. Please see the study for all other authors’ relevant financial disclosures.