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Invokana maintains reduction in weight loss, BP at 1 year
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CHICAGO — Long-term canagliflozin use was associated with reduced body weight and a dose-dependent reduction in BP compared with placebo among patients with type 2 diabetes, according to findings presented at the American Heart Association Scientific Sessions.
Muhammad Shahzeb Khan, MD, of the department of internal medicine at John H. Stroger Jr. Hospital of Cook County in Chicago, told Cardiology Today that the findings demonstrate the efficacy of canagliflozin (Invokana, Janssen) for the prevention and control of hypertension in this patient population.
“An additional benefit is that the reduction in BP is not associated with increased hypotensive episodes,” he said.
Canagliflozin is an SGLT2 inhibitor that was first approved by the FDA in 2013 to help improve glycemic control, along with diet and exercise, in adults with type 2 diabetes. The FDA recently approved an expanded indication to include language in the prescribing information that canagliflozin can reduce the risk for major adverse CV events, including MI, stroke and CV-related death, in adults with type 2 diabetes and established CVD. The approval makes canagliflozin the third diabetes drug to receive a CV indication and the first oral type 2 diabetes treatment to receive a specific major adverse CV events indication.
Although short-term canagliflozin use has previously been shown to reduce body weight and BP, less is known about its long-term impact, according to Khan. It is also unclear whether the effect of canagliflozin is dose-dependent.
To investigate the long-term benefit of canagliflozin, Khan and colleagues conducted a meta-analysis of five randomized controlled trials examining the drug for at least 1 year in 15,230 patients with type 2 diabetes. They also compared the outcomes of patients who received 100 mg and 300 mg of canagliflozin.
The researchers observed a significant reduction in body weight with canagliflozin use compared with placebo that lasted for at least 1 year, regardless of dose (weighted mean difference = 3.32%; 95% CI, -4.04 to -2.60). Canagliflozin also significantly reduced both systolic BP (weighted mean difference = 4.40 mm Hg; 95% CI, -5.18-3.62) and diastolic BP (weighted mean difference = 1.68; 95% Ci, -2.14 to -1.23) compared with placebo. The effect was stronger with the 300-mg dose of canagliflozin for both systolic (P = .02) and diastolic (P = .01) BP.
Khan reported that improved CV outcomes associated with canagliflozin may be linked to these favorable changes in body weight and BP. Moving forward, he said it would be interesting to compare the long-term use of canagliflozin with other subtypes of SGLT2 inhibitors.
“Canagliflozin has been studied in more long-term trials than other SGLT2 inhibitors,” he said. “However, data from large-scale trials of empagliflozin (EMPA-REG) and dapagliflozin (DECLARE-TIMI 58) provide robust evidence that these drugs also result in similar reductions in body weight and blood pressure that last at least 1 year.” – by Stephanie Viguers
Reference:
Khan MS, et al. Abstract 2303. Presented at: American Heart Association Scientific Sessions; Nov. 10-12, 2018; Chicago.
Disclosure: Khan reports no relevant financial disclosures.