Canagliflozin demonstrates improved glycemic control in type 2 diabetes

NEW ORLEANS — Patients with type 2 diabetes treated with canagliflozin in a real-world setting achieved a greater reduction in HbA1c compared with patients who received sitagliptin, according to study results presented at the American Diabetes Association Scientific Sessions.

“These study results are very important because we know we have clinical trial data – within clinical trial settings – that canagliflozin shows superior reductions in HbA1c versus sitagliptin,” Richard Aguilar, MD, medical director of Diabetes Nation in Oregon, told Endocrine Today.

Richard Aguilar

Canagliflozin (Invokana, Janssen) – an SGLT2 inhibitor – has previously demonstrated improved glycemic control compared with sitagliptin (Januvia, Merck) – a DPP-4 inhibitor – in various clinical trials. However, as Aguilar noted, real-world evidence among patients treated in traditional clinical practice has been limited.

Aguilar and colleagues analyzed data from a U.S. insurance claims database and included commercial and Medicare Advantage members who had evidence of type 2 diabetes and were prescribed either sitagliptin or canagliflozin between April and December 2013.

The researchers identified patient cohorts in the order of market entry to maximize sample sizes.

Patients who received sitagliptin (n = 12,153) were older than patients who received canagliflozin (n =3,993) (62.4 vs. 55.3 years). The sitagliptin cohort also comprised more Medicare Advantage members (47.9% vs. 10.5%) and the cohort had greater mean baseline comorbidity as measured by the diabetes complications severity index (1.1 vs. 0.8) (P < .001 for all).

After propensity matching (n = 1,472 for each cohort), patients who received canagliflozin had greater HbA1c change between baseline and follow-up (–0.93% vs. –0.57%; P = .004).

In a subset of matched patients who had a baseline HbA1c ≥ 7%, HbA1c change was also greater for individuals who received canagliflozin (–1.08% vs. –0.71%; P = .01).

“It is meaningful [to my practice] to select a once-a-day oral agent that has multiple benefits, as well as greater reductions of HbA1c,” Aguilar said. “I get more for my buck in using a class-agent like canagliflozin [rather than] sitagliptin.” – by Ryan McDonald

Reference:

Aguilar R, et al. 1224-P. Presented at: American Diabetes Association’s Scientific Sessions; June 10-14, 2016; New Orleans.

Disclosures: Aguilar reports serving on advisory boards and speaker’s bureaus for Boehringer Ingelheim, Eli Lilly, Janssen and Takeda.