CANVAS – canagliflozin and cardiovascular or renal influence for diabetes mellitus type 2

Česká verzia

Authors: Vítovec J. ¹; Špinar J. ²; Špinarová L. ¹
Authors place of work: I. interní kardioangiologická klinika LF MU a FN u sv. Anny v Brně ¹; Lékařská fakulta MU Brno ²
Published in the journal: Kardiol Rev Int Med 2019, 21(1): 15-18

Summary

Canagliflozin is a sodium-glucose cotransporter 2 inhibitor that reduces glycaemia as well as blood pressure, body weight, and albuminuria in people with diabetes. The CANVAS Programme integrated data from two trials involving a total of 10,142 participants with type 2 diabetes and high cardiovascular risk. Participants in each trial were randomly assigned to receive canagliflozin or placebo and were followed for a mean of 188.2 weeks. The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Conclusions: In two trials involving patients with type 2 diabetes and an elevated risk of cardiovascular disease, patients treated with canagliflozin had a significantly lower risk of cardiovascular events than those who received placebo. A boundary higher risk of amputation, primarily at the level of the toe or metatarsus was observed in the study. These complications, however, were not proved in subsequent observational databases.

Keywords:

cardiovascular and renal safety – type 2 diabetes mellitus – canagliflozin – programme CANVAS

Zdroje

1. Niessner A, Tamargo J, Koller L et al. Non-insulin antidiabetic pharmacotherapy in patients with established cardiovascular disease: a position paper of the ESC Working Group on Cardiovascular Pharmacotherapy. Eur Heart J 2018; 39(24): 2274– 2281. doi: 10.1093/ eurheartj/ ehx625.

2. Neal B, Perkovic V, Mahaffey KW et al. CANVAS Program Collaborative Group. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med 2017; 377(7): 644– 657. doi: 10.1056/ NEJMoa1611925.

3. Rådholm K, Figtree G, Perkovic V et al. Canagliflozin and heart failure in type 2 diabetes mellitus. Results From the CANVAS Program. Circulation 2018; 138(5): 458– 468. doi: 10.1161/ CIRCULATIONAHA.118.034222.

4. Edelsberger T. Glukuretika (inhibitory SGLT2, glifloziny) v léčbě diabetu. Remedia 2011; 21: 46– 53.

5. Heerspink HJ, Perkins BA, Fitchett DH et al. Sodium glucose cotransporter 2 inhibitors in the treatment of diabetes mellitus: cardiovascular and kidney effects, potential mechanisms, and clinical applications. Circulation 2016; 134(10): 752– 772. doi: 10.1161/ CIRCULATIONAHA.116.021887.

6. Wilding JP, Woo V, Soler NG et al. Sustained effectiveness of dapagliflozin over 48 weeks in patients with type 2 diabetes poorly controlled with insulin. Diabetes 2010; 59 (Suppl. 1): Abstract 0021– LB.

7. Adamíková A. Kanagliflozin – místo v léčbě diabetes mellitus 2. typu. Farmakoterapeutická Revue 2018; 1: 8– 13.

8. SPC Invokana. Dostupné na: http:/ / www.sukl.cz/ modules/ medication/ detail.php?code=0194605&tab=prices.

9. Yuan Z, DeFalco FJ, Ryan PB et al. Risk of lower extremity amputations in people with type 2 diabetes mellitus treated with sodium-glucose co-transporter-2 inhibitors in the USA: A retrospective cohort study. Diabetes Obes Metab 2018; 20(3): 582– 589. doi: 10.1111/ dom.13115.

10. Ryan PB, Buse JB, Schuemie MJ et al. Comparative effectiveness of canagliflozin, SGLT2 inhibitors and non-SGLT2 inhibitors on the risk of hospitalization for heart failure and amputation in patients with type 2 diabetes mellitus: A real-world meta-analysis of 4 observational databases (OBSERVE-4D). Diabetes Obes Metab 2018; 20(11): 2585– 2597. doi: 10.1111/ dom.13424.

11. Bode B, Stenlöf K, Harris S. Long-term efficacy and safety of CANA over 104 weeks in patients aged 55 to 80 years with type 2 diabetes. Diabetes Obes Metab 2015; 17(3): 294– 303. doi: 10.1111/ dom.12428.

12. Jardine MJ, Mahaffey KW, Neal B et al. The canagliflozin and renal endpoints in diabetes with established nephropathy clinical evaluation (CREDENCE) study rationale, design and baseline characteristics. Am J Nephrol 2017; 46(6): 462– 472. doi: 10.1159/ 000484633.

13. Palmer C. CREDENCE canagliflozin trial halted because of efficacy. Cardiology News 2018. Available at: https://www.mdedge.com/cardiology/article/170423/diabetes/credence-canagliflozin-trial-halted-because-efficacy.