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Dr Anirban Majumdar, Kolkata 19 November 2018

The CANVAS Program integrated data from two trials with a total of 10,142 participants with type 2 diabetes and high cardiovascular (CV) risk. The primary outcome was a composite of death from CV causes, nonfatal myocardial infarction or nonfatal stroke.
The rate of the primary outcome was found to be lower with canagliflozin than with placebo (26.9 vs. 31.5 participants per 1,000 patient-years; hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.75-0.97). Additionally, there was a lower risk of hospitalization for heart failure with canagliflozin.
Thus, canagliflozin, compared to placebo, was associated with a lower frequency of adverse CV events.
The US FDA has approved canagliflozin to reduce the risk of heart attack, stroke or CV death in adults with type 2 diabetes and established CVD. Canagliflozin is now the only oral diabetes treatment approved to reduce the risk of these CV events.
The lack of heterogeneity in results across countries, despite geographic variations in the use of specific SGLT-2 inhibitors, suggests a class effect of SGLT-2 inhibitors. Initiation of canagliflozin in T2DM and with established CVD is associated with a lower risk of mortality, hospitalization for heart failure and major adverse cardiovascular events (MACE). Clinical trial results on canagliflozin are reproducible in broad general patient population.

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