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Dr AK Singh, Kolkata 27 November 2018

The beneficial pleiotropic effects of canagliflozin within the CV system and renal system, together with its favorable safety profile, make it an attractive medication.
The US FDA has approved canagliflozin to reduce the risk of heart attack, stroke or CV death in adults with T2DM and established CVD. The EU has updated the label of canagliflozin for CV risk reduction. Health Canada has approved canagliflozin for reduction of major adverse cardiovascular events (MACE).
Canagliflozin increases the odd of regression of albuminuria and also causes a decrease in risk of progression of albuminuria.
In CANVAS Program, the reduction in risk of MACE, hospitalization for heart failure (HHF) and progression of kidney disease appeared similar with canagliflozin across different levels of kidney function down to eGFR 30 mL/min/1.73 m2.
OBSERVE-4D trial examined the real-world comparative effectiveness within the SGLT2i class and compared with non-SGLT2i antihyperglycemic agents. Canagliflozin was associated with a 61% reduction in the risk of HHF compared to non-SGLT2i in overall T2DM patients. There was no increased risk of BKLE amputation with canagliflozin vs. other SGLT2i and non-SGLT2i therapies in overall T2DM patients or in patients with established CVD.
Benefit in renal outcome in CREDENCE looks exciting!

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