What are the effects of canagliflozin and liraglutide combination therapy?

  • Ali AM & al.
  • Diabetes Care
  • 27 Mar 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Combination canagliflozin plus liraglutide therapy does not exert an additive action on glucose control in patients with type 2 diabetes (T2D), but does increase weight loss.

Why this matters

  • The 2 are often prescribed together.

Study design

  • 45 patients with T2D and HbA1c 7%-11% received 9-hour measurement of endogenous glucose production (EGP) and were randomly assigned to liraglutide 1.2 mg/day, canagliflozin 100 mg/day, or liraglutide 1.2 mg plus canagliflozin 100 mg for 16 weeks; then EGP measurement was repeated.
  • Funding: Janssen Pharmaceuticals.

Key results

  • Mean HbA1c decreases from baseline to 16 weeks:
    • Combination: −1.67 (P=.0001).
    • Canagliflozin: −0.89 (P=.002). 
    • Liraglutide: −1.44 (P=.004).
    • No significant differences among treatments.
  • Mean body weight decreases from baseline:
    • Combination: −6.0 kg (P<.0001>
    • Canagliflozin: −3.5 kg (P<.0001>
    • Liraglutide: −1.9 kg (P=.03).
    • Steeper with the combination vs canagliflozin (P=.01) or liraglutide (P=.002).
  • With canagliflozin, basal EGP (bEGP) increased by 9.17% (P=.05), and plasma glucagon-to-insulin ratio rose by 50% (P=.002).
  • With liraglutide, bEGP decrease increased by 8% (P=.02), but the drop in glucagon-to-insulin ratio was nonsignificant.
  • With the combination, bEGP increased 16% (P<.01 which was significantly greater vs liraglutide alone but not canagliflozin>

Limitations

  • No placebo group.
  • Food intake, physical activity not measured.