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Invokana added to antihyperglycemics benefits patients with type 2 diabetes
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The sodium-glucose cotransporter 2 inhibitor Invokana reduced HbA1c, body weight and blood pressure for adults with type 2 diabetes already assigned DPP-IV inhibitor or glucagon-like peptide-1 receptor agonist therapies, according to research in Diabetes, Obesity and Metabolism.
Gregory Fulcher, MD, FRACP, of the Royal North Shore Hospital and University of Sydney in Australia, and colleagues analyzed data from a subset of patients with type 2 diabetes and a history of cardiovascular disease participating in the CANVAS study who were on a background therapy of DPP-IV inhibitors (n = 316; mean age, 63 years; mean HbA1c, 8.1%; mean BMI, 32.3 kg/m²) or GLP-1 receptor agonists (n = 95; mean age, 61 years; mean HbA1c, 8.1%; mean BMI, 37.4 kg/m²), either alone or combined with other antihyperglycemic agents. Participants in the study were randomly assigned Invokana (canagliflozin, Janssen) 100 mg, 300 mg or placebo once daily for 18 weeks; randomization was not stratified by baseline use of background therapies. Researchers measured the change from baseline in HbA1c, fasting plasma glucose, systolic BP and change in body weight, as well as safety and tolerability. Within the cohort, 93% of patients assigned DPP-IV inhibitors and 95% of patients assigned GLP-1 receptor agonists completed the 18-week treatment period.
Researchers found that more patients treated with canagliflozin 100 mg or 300 mg achieved an HbA1c of 7% or lower vs. placebo in both the DPP-IV group (21.8% and 34.3% vs. 14.6%, respectively) and the GLP-1 group (29.4% and 34.5% vs. 6.9%, respectively). FPG, systolic and diastolic BP were also lower with both doses of canagliflozin vs. placebo in both groups. Both the DPP-IV and GLP-1 groups also lost more body weight with both doses of canagliflozin vs. placebo.
Both the DPP-IV and GLP-1 groups reported increasing adverse events; many attributable to the SGLT2 inhibitor mechanism of canagliflozin, according to researchers. Participants in both groups assigned canagliflozin 300 mg reported more genital mycotic infections, urinary tract infections, postural hypotension and dizziness than those assigned canagliflozin 100 mg or placebo. In the DPP-IV group, rates of documented hypoglycemia were 24.3%, 33.3% and 16.2% among those assigned canagliflozin 100 mg, 300 mg or placebo, respectively. In the GLP-1 group, rates of documented hypoglycemia were 37.9%, 50% and 15.4% among those assigned canagliflozin 100 mg, 300 mg or placebo, respectively.
“Canagliflozin provided consistent glycemic benefits, weight loss and BP reductions in patients with type 2 diabetes who were on a background [antihyperglycemic agent] regimen including DPP-IV inhibitors or GLP-1 receptor agonists over 18 weeks, and was generally well tolerated, with a similar safety profile to that reported in previous phase 3 studies of canagliflozin,” the researcher wrote. – by Regina Schaffer
Disclosure: Fulcher reports serving on advisory boards for Johnson & Johnson and as a consultant to Janssen. Please see the full study for the other authors’ relevant financial disclosures.
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