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Greater CV benefit with canagliflozin vs. other diabetes drugs
Adults with type 2 diabetes beginning treatment with canagliflozin may have a lower risk for hospital admissions for heart failure, acute myocardial infarction, ischemic stroke or hemorrhagic stroke compared with those beginning treatment with DPP-IV inhibitors, GLP-1 receptor agonists or sulfonylureas, according to results of a health care database study.
Elisabetta Patorno, MD, DrPH, assistant professor of medicine at Harvard Medical School and associate epidemiologist in the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women’s Hospital, and colleagues evaluated data from the Optim Clinformatics datamart on adults with type 2 diabetes who initiated the SGLT2 inhibitor canagliflozin (Invokana, Janssen), a DPP-IV inhibitor, a GLP-1 receptor agonist or a sulfonylurea between April 2013 and September 2015. Researchers sought to determine the effects of each medication on hospital admission for heart failure and on a cardiovascular endpoint that included hospital admission for acute MI, ischemic stroke or hemorrhagic stroke.
Participants were divided into three propensity score-matched cohorts. Cohort one consisted of 17,667 pairs of people who initiated canagliflozin (mean age, 56.5 years; 44.9% women) or a DPP-IV inhibitor (mean age, 56.5 years; 45% women). Cohort two consisted of 20,539 pairs of people who initiated canagliflozin (mean age, 56.8 years; 47.3% women) or a GLP-1 receptor agonist (mean age, 56.7 years; 47.2% women). Cohort three consisted of 17,354 pairs of people who initiated canagliflozin (mean age, 55.9 years; 45% women) or a sulfonylurea (mean age, 55.8 years; 45.2% women). Follow-up was a mean 0.6 years.
The number of heart failure events was lower among all participants initiating canagliflozin compared with a DPP-IV inhibitor (canagliflozin, 91 events vs. DPP-IV inhibitor, 124 events; HR = 0.7; 95% CI, 0.54-0.92), a GLP-1 receptor agonist (canagliflozin, 94 events vs. GLP-1 receptor agonist, 148 events; HR = 0.61; 95% CI, 0.47-0.78) and a sulfonylurea (canagliflozin, 77 events vs. sulfonylurea, 154 events; HR = 0.51; 95% CI, 0.38-0.67). The number of the composite CV endpoint events was lower in participants initiating canagliflozin compared with a DPP-IV inhibitor (101 events vs. 108 events; HR = 0.89; 95% CI, 0.68-1.17) and a sulfonylurea (93 events vs. 110 events; HR = 0.86; 95% CI, 0.65-1.13); the event rate was higher in the canagliflozin group compared with the GLP-1 receptor agonist group (11 events vs. 102 events; HR = 1.03; 95% CI, 0.79-1.35). Findings remained consistent after adjustment for baseline HbA1c and presence of CVD at baseline.
“Our investigation shows the potential cardiovascular benefits of canagliflozin vs. other diabetes drugs as used in routine care,” the researchers wrote. “Our study also supports the increasing role of large pharmacoepidemiologic studies based on longitudinal data routinely generated in the provision of health care for millions of patients, to provide valid and timely information on the safety and effectiveness of glucose-lowering drugs in use as a complement to and in anticipation of study results on cardiovascular outcomes.” – by Amber Cox
Disclosures: Patorno reports she receives research grants from Boehringer-Ingelheim and GlaxoSmithKline not directly related to the topic of the submitted work. Please see the study for all other authors’ relevant financial disclosures.