ADA 2019—In T2D, cardiovascular disease, kidney failure risks are reduced with canagliflozin


  • Emily Willingham, PhD
  • Conference Reports
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Takeaway

  • Patients who have both type 2 diabetes (T2D) and kidney disease fare better in both renal and cardiovascular outcomes with canagliflozin treatment vs placebo.
  • The sodium-glucose cotransporter-2 inhibitor confers a protective effect against progression of kidney disease, according to these results from CREDENCE .

Why this matters

  • Some data from cardiovascular trials suggest a renal-protective effect of these drugs.
  • Editorial: The importance of this “well-done and large clinical trial…cannot be overstated.” 

Key results

  • The trial was ended early because of interim results.
  • Median follow-up at cessation was 2.62 years.
  • For primary outcome of composite renal/cardiovascular outcomes, with canagliflozin vs placebo:
    • 43.2 and 61.2 events per 1000 patient-years;
    • HR, 0.70 (95% CI, 0.59-0.82; P=.00001).
  • For renal-specific outcomes (composite), canagliflozin vs placebo: 
    • HR, 0.66 (95% CI, 0.53-0.81; P<.001>
  • For cardiovascular-specific outcomes, canagliflozin vs placebo:
    • HR, 0.80 (95% CI, 0.67-0.95; P=.01) for cardiovascular death/myocardial infarction/stroke;
    • HR, 0.61 (95% CI, 0.47-0.80; P<.001 for hospitalization heart failure.>

Study design

  • Double-blind, randomized trial, 100 mg/day canagliflozin or placebo for patients with T2D, chronic kidney disease (4401 enrolled at cessation).
  • Primary outcome: composite of end-stage kidney disease/doubling serum creatinine/renal or cardiovascular death.
  • Funding: Janssen Research and Development.

Limitations

  • Longer-term outcomes not known.

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