Anti-diabetes drug found to cut risk of heart, kidney disease

Jane Richards
June 13, 2017

Johnson & Johnson's SGLT2 inhibitor Invokana has become the second drug in the SGLT2 inhibitor class to reduce cardiovascular outcomes in type 2 diabetes patients, but with an increased risk of lower-limb amputation. The research has also indicated a significant impact on the progression of kidney disease, as the patients were 40 per cent lesser prone to develop a kidney disease.

Lead researcher Professor Bruce Neal, from the George Institute for Global Health, said: "Coronary heart disease is the biggest killer by far for people with type 2 diabetes".

Invokana (canagliflozin), an approved medication for type 2 diabetes, led to a 14% risk reduction in the Phase 3 CANVAS study's composite primary endpoint - comprised of nonfatal myocardial infarction (MI), cardiovascular (CV) death and nonfatal stroke.

There are more than four million people in the United Kingdom living with diabetes, 90 per cent of whom have type 2.

Study lead Prof John Petrie, from the University of Glasgow's Institute of Cardiovascular and Medical Sciences, said: "The results from this trial are significant because now cardiovascular disease is a major cause of reduced life expectancy in type 1 diabetes, and cardiovascular disease rates are more than double those of the background population".

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The diabetes drug was also found to reduce risk of hospitalization for heart failure and provides protection against kidney function decline. What we have done is show that the earlier results were not just a one-off.

It is recommended by watchdog NICE for patients for whom diet and exercise are not sufficient to keep blood sugar down, and for whom a much more common drug called metformin does not work.

Professor Neal said: "We don't know why there was an increased risk of amputation, and further work is needed in this area". On the downside, the risk of amputation with Invokana was twice as high as with placebo-although the risk overall was low. This causes in more glucose being released in the urine which thereby reduces the glucose levels of blood.

SGLT-2 inhibitors are one of the more promising classes popping up in diabetes, given their promise in preventing cardiovascular problems. The highest absolute risk of amputation occurred in patients with a prior history of amputation or peripheral vascular disease, but the relative risk for amputation with canagliflozin was comparable across these subgroups. Australian researcher from The George Institute for Global Health, Prof. Less positive was a doubling in risk of amputations associated with canagliflozin use.

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