Canagliflozin improves renal outcomes in people with type 2 diabetes mellitus (T2DM) with or at high risk for cardiovascular (CV) disease, according to data recently presented at the 2018 National Kidney Foundation’s Spring Clinical Meetings in Austin, Texas.. This benefit was observed in people with both preserved and reduced kidney function, as measured by estimated glomerular filtration rate (eGFR) above or below 60 mL/min/1.73 m2.
In the new analysis, canagliflozin reduced the urinary albumin to creatinine ratio (UACR), a key biomarker for chronic kidney disease, from baseline eGFR in patients with preserved and reduced eGFR by 17 percent and 23 percent, respectively (P-heterogeneity=0.01). Canagliflozin also resulted in a relative risk reduction of the pre-specified composite endpoint (40 percent decline in eGFR, end-stage kidney disease or renal death) by 47 percent (HR, 0.53; 95% CI, 0.39 to 0.73, P-heterogeneity=0.28) in patients with preserved eGFR and 24 percent (HR, 0.76; 95% CI, 0.49 to 1.17, P-heterogeneity=0.28) in patients with reduced eGFR. Findings were similar when doubling of serum creatinine was substituted for 40 percent decline in eGFR in the renal composite (P-heterogeneity=0.21). There was no difference in risk of serious adverse events with canagliflozin in the two patient subgroups and no new adverse events were observed during this additional analysis beyond those previously reported from the CANVAS Program.
“Diabetic kidney disease remains the most common cause of end-stage renal disease worldwide, which underscores the need to further explore the potential renal protective effects of SGLT2 inhibitors,” says George Bakris, MD, professor of Medicine and Director, Comprehensive Hypertension Center, University of Chicago Medicine. “The new analysis adds to the body of evidence, which suggests canagliflozin could potentially improve renal outcomes for millions of people with type 2 diabetes and suggests this benefit can be observed in people who have preserved and reduced kidney function.”
“Although roughly one in three adults with diabetes develops diabetic kidney disease, there have been no significant advances in treatment for patients,” says James F. List, MD, PhD, Global Therapeutic Area Head, Cardiovascular & Metabolism, Janssen Research & Development, LLC. (Janssen is marketing the drug as INVOKANA.) “We are encouraged that canagliflozin could potentially provide much-needed benefit for those with diabetic kidney disease, and look forward to building further on this insight in CREDENCE, the fully recruited and first dedicated SGLT2 inhibitor trial evaluating renal and cardiovascular outcomes in people with type 2 diabetes and kidney disease.”