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Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy
Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy
Valeska Semiramis Briones Vargas
Definition
Canagliflozin, sold under the brand name Invokana among others, is a drug used to treat type 2
diabetes. It is a third-line drug that should be tried after metformin, a first-line drug for type 2
diabetes. Use in conjunction with exercise and diet.
Application in medicine
The primary objective (OP) defined as: ESRD renal composite (dialysis arrival, kidney
transplant or glomerular filtration rate less than 15 ml/min/1.73 m²) or 2 times or more of
baseline creatinine (doubling or more of the baseline creatinine) or renal death or cardiovascular
death.
Reduction of the primary objective (OP) by 30% from 43.2 to 61.2 events per 1,000
patients per year (NNT of 22).
Reduction of renal composite or 2x creatinine or renal death by 34% (NNT of 28).
The follow-up was interrupted prematurely at 2.62 years because objectives had been
achieved. Summarizing the results:
Reduction of ESRD renal composite by 32% (NNT of 43).
Reduction of 2x basal creatinine of 40%. The loss of glomerular filtrates per year of 3.19 vs. 4.71 ml/min/1.73 m².
Pros and Cons
Urinary albumin excretion in the treated group was 31% lower.
Reduced risk of cardiovascular death or non-fatal acute myocardial infarction or nonfatal stroke by 20%.
39% reduction in the risk of admission for congestive heart failure.
Issue applied in Ecuador
The Chilean Public Health Institute (ISP) has reported that it is in the process of reviewing the safety content of the information brochures for professionals and patients of pharmaceutical
products containing: canagliflozin, dapagliflozin and empagliflozin, belonging to the group of
inhibitors of the sodium-glucose transporter type 2 (SGLT2), indicated to treat type 2 diabetes
mellitus in adult patients.
Conclusion
In type 2 diabetes, in the last 15 years and since the classic RENAAL studies (with losartan) or
IDNT (with irbesartan), all studies with multiple therapeutic targets had failed in the treatment
of diabetic nephropathy. If these results are confirmed in clinical practice, many diabetics will
delay or not reach dialysis and we will always have reduced a significant part of their
cardiovascular risk. The good results of the CREDENCE study add to the effective
nephroprotection achieved with this family in much less advanced stages of diabetic kidney
disease.