Further support for cardiovascular benefits of canagliflozin
medwireNews: Results of a US database study suggest that the sodium-glucose co-transporter-2 (SGLT2) inhibitor canagliflozin is associated with a lower risk for heart failure hospitalization compared with three other classes of antidiabetes agent.
These results demonstrate that the “reduction in hospital stays for heart failure showed for canagliflozin in the CANVAS trial extends to [real-world] settings and consistently occurs in direct comparisons with three clinically relevant diabetes treatment alternatives,” write the study authors in The BMJ.
Elisabetta Patorno (Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA) and colleagues used a nationwide commercial healthcare database to compare rates of hospital admission for heart failure among patients with type 2 diabetes who initiated treatment with canagliflozin or a non-gliflozin antidiabetic agent between 2013 and 2015. Patients were separated into three cohorts based on the comparator agent.
In the first cohort, 91 of 17,667 canagliflozin-treated patients were hospitalized for heart failure over a mean follow-up of 0.6 years, compared with 124 of 17,667 propensity-matched patients who were treated with a dipeptidyl peptidase-4 (DPP-4) inhibitor, giving event rates of 8.9 versus 12.8 per 1000 person–years and a significant hazard ratio (HR) of 0.70.
Similarly, rates of heart failure hospitalization were 7.5 versus 12.4 per 1000 person–years for 20,539 matched pairs of patients treated with canagliflozin versus a glucagon-like peptide (GLP)-1 receptor agonist (HR=0.61), and 7.3 versus 14.4 per 1000 person–years (HR=0.51) for the 17,354 matched pairs treated with canagliflozin versus a sulfonylurea.
These findings “[respond] to the need of confirmatory evidence” following exploratory data in the CANVAS and EMPA-REG OUTCOME trials, and suggest “that the potential beneficial effect of canagliflozin with regard to heart failure admission to hospital tends to occur early, within the first six months after treatment,” write the researchers.
However, in contrast to this “markedly decreased” risk for heart failure hospitalization, the team found “no meaningful difference” in rates of hospital admission for acute myocardial infarction or stroke between patients treated with canagliflozin versus DPP-4 inhibitors, GLP-1 receptor agonists, and sulfonylureas.
Patorno and co-authors caution that the database did not include information on cardiovascular mortality and other outcomes that “may be relevant for treatment decisions in diabetes care,” such as fractures and amputations. They also note that because canagliflozin has only been available since 2013, “its long term effects will need to be further studied.”
Nevertheless, the team believes that their results “complement cardiovascular outcome trials by enriching the understanding of the cardiovascular effects of these drugs compared directly with clinically relevant diabetes treatment alternatives among patients with type 2 diabetes in routine practice.”
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