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Canagliflozin: A Review in Type 2 Diabetes

Abstract

Canagliflozin (Invokana®) is a sodium-glucose co-transporter-2 (SGLT2) inhibitor indicated in various countries worldwide for the once-daily oral treatment of type 2 diabetes (T2D). Canagliflozin lowers blood glucose levels independently of insulin, with the inhibition of SGLT2 reducing renal reabsorption of glucose and increasing excretion of glucose in the urine. In well-designed clinical trials, canagliflozin (as first-line monotherapy or add-on therapy to other antihyperglycaemic agents) improved glycaemic control in adults with T2D, including those of older age and/or at high cardiovascular (CV) risk, and also had beneficial effects on their bodyweight and blood pressure (BP). CV risk reduction, as well as possible renal benefits, were also seen with canagliflozin in T2D patients at high CV risk in the CANVAS Program, an integrated analysis of two large CV outcomes studies. Canagliflozin was generally well tolerated, had a low risk of hypoglycaemia and was most commonly associated with adverse events such as genital and urinary tract infections and increased urination, consistent with its mechanism of action. Although the amputation and fracture risk observed among recipients of the drug require further investigation, canagliflozin is an important option for T2D management in adults.

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Acknowledgements

During the peer review process, the manufacturer of canagliflozin was offered the opportunity to review this article. Changes resulting from comments received were made on the basis of scientific and editorial merit.

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Correspondence to Emma D. Deeks.

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The preparation of this review was not supported by any external funding.

Conflict of interest

Emma Deeks is a salaried employee of Adis/Springer, is responsible for the article content and declares no relevant conflicts of interest. André J. Scheen declares no relevant conflicts of interest related to the content of this review. He has received lecturer/advisor/investigator fees from AstraZeneca, Boehringer Ingelheim, Eli Lilly, GlaxoSmithKline, Janssen, Merck Sharp & Dohme, Novartis, NovoNordisk and Sanofi, and has worked as a clinical investigator in the TECOS, LEADER, EMPA-REG OUTCOME and CANVAS-R trials.

Additional information about this Adis Drug Review can be found at http://www.medengine.com/Redeem/2D48F06076B1EACC.

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The manuscript was reviewed by: D. S. H. Bell, Southside Endocrinology, Mountain Brook, AL, USA; M. J. Budoff, Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA; G. Dimitriadis, 2nd Department of Internal Medicine, Research Institute & Diabetes Center, Athens University Medical School, Attikon University Hospital, Athens, Greece; J. C. de Lima - Júnior, Internal Medicine Department, University of Campinas, Campinas, Brazil; J. G. Eriksson, Department of General Practice & Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland and Folkhälsan Research Center, Helsinki, Finland; M. C. Mancini, Sao Paulo University, Endocrinology & Metabology Service and Obesity & Metabolic Syndrome Unit, Hospital das Clinicas/Secretaria Endocrinologia, Sao Paulo, Brazil.

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Deeks, E.D., Scheen, A.J. Canagliflozin: A Review in Type 2 Diabetes. Drugs 77, 1577–1592 (2017). https://doi.org/10.1007/s40265-017-0801-6

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