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Real-world efficacy differs among SGLT2 inhibitors
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Adults with type 2 diabetes more often reached their glycemic goal and had greater reductions in HbA1c level when they were prescribed canagliflozin vs. dapagliflozin, according to an analysis of claims data for the SGLT2 inhibitors.
“Controlling blood glucose levels is central to diabetes treatment because it can reduce the risk of diabetes-related complications, such as kidney disease, retinopathy and, potentially, cardiovascular disease,” Lawrence Blonde, MD, director of the Ochsner Diabetes Clinical Research Unit at the Frank Riddick Diabetes Institute, Ochsner Medical Center, in New Orleans, said in a press release. “This first real-world analysis comparing SGLT2 [inhibitor] therapies in adults with type 2 diabetes showed that canagliflozin (Invokana, Janssen) 300 mg each day allowed more patients to achieve blood glucose control … than did a daily dose of dapagliflozin (Farxiga, AstraZeneca) 10 mg.”
In a U.S. retrospective cohort study, Blonde and colleagues assessed the real-world efficacy of canagliflozin and dapagliflozin for decreasing HbA1c in 2,546 patients with type 2 diabetes selected from the Optum Clinformatics claims database. Patients received at least one prescription for canagliflozin (n = 1,982) or dapagliflozin (n = 564) between 2014 and September 2016. Researchers used propensity score matching to create matched cohorts of 558 patients.
The study’s primary outcome was defined as the percentage of patients who achieved an HbA1c level less than 8% (Healthcare Effectiveness Data and Information Set [HEDIS] target). Secondary outcomes included the proportion of patients to achieve the American Diabetes Association target of HbA1c less than 7% and the percentage of patients with poor control, defined as HbA1c greater than 9%. Treatment patterns were also assessed during the 6-month post-index period, including discontinuation, medication switching or add-on and adherence.
At 6 months after the index date, researchers found that a higher percentage of patients assigned canagliflozin vs. dapagliflozin attained HbA1c less than 8% (70.8% vs. 59.1%; OR = 1.6; 95% CI, 1.26-2.04) and HbA1c less than 7% (36.7% vs. 25.1%; OR = 1.75; 95% CI, 1.34 -2.27). The two groups had similar percentages of patients with HbA1c greater than 9%.
At 6 months post-index, mean HbA1c was lower in the canagliflozin vs. the dapagliflozin group (7.57% vs. 7.85%; mean difference, –0.28%; 95% CI, –0.44 to –0.13). The mean HbA1c reduction was 1.17% with canagliflozin and 0.91% with dapagliflozin (P = .0049). A sensitivity analysis in the on-treatment population yielded HbA1c results similar to those of the primary analysis.
Patients assigned canagliflozin were less likely to cease treatment vs. those assigned dapagliflozin (OR = 0.75; 95% CI, 0.58-0.99) or to switch medication (OR = 0.72; 95% CI, 0.54-0.96).
“These findings suggest that treatment with canagliflozin 300 mg vs. dapagliflozin 10 mg may help more patients with [type 2 diabetes] achieve glycemic control in the real world, which may ultimately lead to fewer diabetic complications and improved outcomes,” the researchers wrote.
“Future studies are needed to examine the real-world effects of canagliflozin and dapagliflozin on HbA1c and other parameters (eg, weight, blood pressure) over longer follow-up periods and different populations,” they wrote. – by Jennifer Byrne
Disclosures: Blonde reports he has served as an investigator for AstraZeneca, Janssen, Lexicon, Merck, Novo Nordisk and Sanofi; has served as a speaker for AstraZeneca, Janssen, Novo Nordisk and Sanofi; and has served as a consultant for Intarcia, Janssen Pharmaceuticals, Merck, Novo Nordisk and Sanofi. Please see the study for all other authors’ relevant financial disclosures.
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