Takeaway
- Canagliflozin delayed the time to insulin therapy and the need for initiation of other antihyperglycaemic agents (AHAs) compared with placebo over a 5-year period in patients with type 2 diabetes (T2D) and established cardiovascular disease (CVD) in the CANagliflozin cardioVascular Assessment Study (CANVAS) Program.
Why this matters
- Lower use of insulin and other AHAs associated with canagliflozin may represent reduced utilisation of health services, reduced healthcare costs, better adherence and improved patient satisfaction.
Study design
- Post hoc analysis of CANVAS Program: 2 randomised controlled trials among 10,142 patients with T2D and high CVD risk.
- Randomisation: canagliflozin vs placebo.
- Main outcome: initiation of insulin and other AHAs.
- Funding: Janssen Research & Development, LLC.
Key results
- At 1 year, fewer participants in the canagliflozin vs placebo group initiated any AHA (7% vs 16%), insulin (3% vs 9%) or any non-insulin AHA (5% vs 12%; P<.001 for all).
- Overall AHA initiation increased over time but was consistently lower with canagliflozin vs placebo:
- At 3 years (any AHA: 19% vs 32%; insulin: 9% vs 21%; or non-insulin AHA: 15% vs 26%); and
- At 5 years (any AHA: 28% vs 43%; insulin: 14% vs 30%; or non-insulin AHA: 23% vs 36%).
- Patients treated with canagliflozin vs placebo were less likely to initiate:
- any AHA (HR, 0.47; 95% CI, 0.43-0.51);
- insulin (HR, 0.37; 95% CI, 0.31-0.43); and
- any non-insulin AHA (HR, 0.50; 95% CI, 0.45-0.55; P for all <.001).
- The time difference between 10% of patients in the canagliflozin and placebo groups being initiated on insulin from the beginning of the trial was >2 years.
- Canagliflozin vs placebo delayed the time for initiation of other AHAs, including metformin, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists and sulphonylureas (P<.001 for each).
Limitations
- Post hoc analysis.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.
