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Invokana reduces HbA1c, body weight in metformin-treated patients

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NASHVILLE, Tenn. - Patients with type 2 diabetes assigned metformin showed greater decreases in both HbA1c and body weight when adding Invokana vs. glimepiride, according to study findings presented here.

In a randomized, double blind study, there was a significant reduction in incidence of hypoglycemia in patients assigned two different doses of Invokana (canagliflozin, Janssen) vs. glimepiride, and researchers said the drug was well tolerated.

“In choosing an appropriate therapy for type 2 diabetes, we must consider the effects of the drug on parameters beyond just glycemia, including effects on body weight and risk for hypoglycemia,” Lawrence A. Leiter, MD, FRCPC, FACP, FACE, of St. Michael’s Hospital, University of Toronto, told Endocrine Today.

Lawrence A. Leiter

Leiter and colleagues at other institutions analyzed data from 1,450 patients with type 2 diabetes (average baseline HbA1c, 7.8%; average body weight, 86.6 kg) assigned either 100 mg or 300 mg canagliflozin or glimepiride as an add-on to metformin during a 52-week period, followed by a 52-week extension (n = 1,050). Researchers assessed participants’ changes in HbA1c and body weight from baseline at weeks 52 and 104.

At week 52, mean changes from baseline in HbA1c were -0.82% for 100 mg canagliflozin, -0.93% for 300 mg canagliflozin and -0.81% for glimepiride, whereas changes in body weight from baseline were -4.2% for 100 mg canagliflozin, -4.7% for 300 mg canagliflozin and 1% for glimepiride.

At week 104, mean changes from baseline in HbA1c were -0.65% for 100 mg canagliflozin, -0.74% for 300 mg canagliflozin and -0.55% for glimepiride, whereas changes in body weight from baseline were -4.1% for 100 mg canagliflozin, -4.2% for 300 mg canagliflozin and 0.9% for glimepiride.

At 52 weeks, 84.1% of patients assigned 100 mg canagliflozin and 87.3% of patients assigned 300 mg canagliflozin saw reductions in body weight vs. 32.3% of patients assigned glimepiride.

A larger proportion of patients saw overall reductions in both HbA1c and body weight with both doses of canagliflozin (72.4%, 100 mg canagliflozin; 78.5%, 300 mg canagliflozin) vs. glimepiride (26.8%) at week 52 and at week 104 (65.5%, 100 mg canagliflozin; 71.1%, 300 mg canagliflozin; 26.8%, glimepiride).

Incidence of hypoglycemia also was far lower with 100 mg canagliflozin (7%) and 300 mg canagliflozin (8%) vs. glimepiride (41%).

“[Canagliflozin] provided greater attainment of reduction in both [HbA1c] and [body weight] compared with [glimepiride] at 52 and 104 weeks and was generally well tolerated in patients with [type 2 diabetes] as an add-on to [metformin],” the researchers wrote.

“Moving forward, in assessing the effects of anti-hyperglycemic agents, we must move beyond 6-month, placebo-controlled trials and consider longer-term, head-to-head trials,” Leiter said. - by Regina Schaffer

Reference :

Leiter L, et al. Abstract 413. Presented at: AACE 24th Annual Scientific & Clinical Congress; May 13-17, 2015; Nashville, Tenn.

Disclosure: Leiter reports research funding from, providing CME on behalf of, and/or consulting for AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen, Merck, Novo Nordisk, Roche, Sanofi, Servier and Takeda. One other researcher reports consulting for Janssen and Sanofi.