Canagliflozin 100 mg or 300 mg slowed the progression of renal disease in patients with type 2 diabetes during the course of 2 years compared with glimepiride, according to data published in the Journal of the American Society of Nephrology.
Hiddo J. L. Heerspink, PharmD, PhD, from the Department of Clinical Pharmacy and Pharmacology at the University of Groningen in Groningen, the Netherlands, and colleagues measured the effects of canagliflozin on kidney function decline in 1450 patients with type 2 diabetes who were receiving metformin.
The researchers randomly assigned patients to receive either once-daily canagliflozin 100 mg, canagliflozin 300 mg, or glimepiride uptitrated to 6 to 8 mg. They measured the annual change in eGFR and albuminuria during a follow-up of 2 years.
Patients who received glimepiride had eGFR declines of 3.3 ml/min per 1.73 m2 per year. In addition, patients receiving canagliflozin 100 mg had eGFR declines of 0.5 ml/min per 1.73 m2 per year, while patients who received canagliflozin 300 mg had eGFR declines of 0.9 ml/min per 1.73 m2 per year.
In a subgroup of patients with a baseline urinary albumin-to-creatinine ratio ≥30 mg/g, the ratio decreased significantly more for patients taking canagliflozin 100 mg or canagliflozin 300 mg compared with the patients taking glimepiride.
“The beneficial effects of canagliflozin on kidney function and albuminuria are unlikely to be explained by the modest differential effect on glucose levels, so these findings suggest that SGLT2 inhibitors may be renoprotective, independent of their effects on glycemic control,” the study authors wrote.
Overall, patients who took glimepiride had 1-year HbA1c reductions of 0.81% and 2-year reductions of 0.55%. Patients taking canagliflozin 100 mg had 0.82% 1-year reductions and 0.65% 2-year reductions, while patients taking canagliflozin 300 mg had 0.93% 1-year reductions and 0.74% 2-year reductions.
“Whether the beneficial effects of canagliflozin remain present if all patients receive optimal doses of RAS [renin-angiotensin system] inhibition remains to be studied, but is likely, since our data showed that the effects of canagliflozin were present regardless of the use of background RAS inhibition,” the study authors concluded.
- Heerspink HJL, Desai H, Jardine M, et al. Canaglifozin slows progression of renal function decline independently of glycemic effects. J Am Soc Nephrol. 2016; doi: 10.1681/ASN.2016030278.