Dapagliflozin slows CKD progression in patients with T2D

  • Pollock C & al.
  • Lancet Diabetes Endocrinol
  • 12 Apr 2019

  • International Clinical Digest
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Takeaway

  • Dapagliflozin±saxagliptin added to an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) slows progression of moderate-severe chronic kidney disease (CKD) in patients with type 2 diabetes (T2D).

Why this matters

  • In patients with established T2D and CKD, optimized glycemic control and currently available albuminuria-lowering treatments are insufficient to prevent progressive kidney function loss.

Study design

  • Double-blind, placebo-controlled, multicenter trial. 
  • Included patients with T2D; urine albumin to creatinine ratio (UACR), 30-3500 mg/g; estimated glomerular filtration rate, 25-75 mL/min/1.73 m2; and HbA1c, 7.0%-11.0% (53-97 mmol/mol) receiving ACEI or ARBs and glucose-lowering medications.
  • Participants were randomly allocated to placebo (n=148), 10 mg dapagliflozin (Farxiga; n=145), or dapagliflozin+2.5 mg saxagliptin (Onglyza; n=155) for 24 weeks.
  • Funding: AstraZeneca.

Key results

  • In dapagliflozin group at week 4, difference in mean change from baseline UACR was −28.3% (P<.0001 vs placebo sustained through week difference p=".011).</li">
  • In dapagliflozin+saxagliptin group, those values were −34.5% (P<.0001 and respectively.>
  • Proportions achieving HbA1c
  • 10.3% placebo;
  • 15.0% dapagliflozin: OR vs placebo, 1.7 (P=.17); and
  • 35.1% dapagliflozin+saxagliptin: OR vs placebo, 5.4 (P<.0001>
  • Adverse event patterns comparable to main clinical trials.  
  •  Limitations

    • No saxagliptin-alone group.
    • Short follow-up.
    • Single albuminuria measurement.  

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