SGLT2i vs. GLP-1 Agonist: Treatment Progression, Persistence Compared

Time to reach HbA1c <8% was compared for CANA vs. GLP-1 Agonist
Time to reach HbA1c <8% was compared for CANA vs. GLP-1 Agonist

This article is written live from the American Association of Clinical Endocrinologists (AACE) 2017 Annual Meeting in Austin, TX. MPR will be reporting news on the latest findings from leading experts in endocrinology. Check back for more news from AACE 2017.


At the AACE 2017 Annual Meeting, Carol H. Wysham, MD, of the Rockwood Clinic, Spokane, WA, presented results of a study comparing the efficacy of canagliflozin (CANA) and glucagon-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes mellitus (T2DM) in a real-world setting.

The study aimed at comparing the efficacy of oral CANA 300mg, a sodium-glucose co-transporter 2 inhibitor (SGLT2) vs. an injectable GLP-1 receptor agonist (albiglutide, dulaglutide, exenatide, liraglutide) in terms of persistence, treatment progression, and durability in patients. In order to do this, the study authors utilized the QuintilesIMS EMRs–US database to identify T2DM patients that had been initiated on CANA or a GLP-1 agonist between March 2012 and April 2016. 

Outcomes of the study included mean HbA1c levels measured every 3 months prior to new antihyperglycemic agent (AHA) use, time to reach HbA1c <8%, persistence (no gap of >90 days from last day of supply until next prescription), new AHA use by class, time to new AHA prescription, and time to HbA1c ≥8% and the composite outcome of time to HbA1c ≥8% or having a prescription for new AHA. 

The authors identified 11,435 patients for the CANA group and 11,582 patients for the GLP-1 agonist group. Results of the study found that the time to obtain an HbA1c <8% was similar for the CANA and GLP-1 agonist groups (HR 0.98; 95% CI: 0.91, 1.06; P=0.642). The median time to reach the <8% threshold was 12.4 months vs. 13.1 months, respectively. However, data indicated that “CANA patients were 30% less likely to discontinue (HR 0.70, 95% CI: 0.66, 0.74; P<0.001), with a median time to discontinuation of 12.4 vs. 8.6 months" when compared to GLP-1 agonist patients.

Results of the study also found that patients receiving CANA were 28% less likely to add or switch to a new AHA (HR 0.72; 95% CI: 0.68, 0.77; P<0.001). Although the treatment groups did not significantly differ when examining the failure to maintain HbA1c <8% outcome, the authors reported that “CANA patients were 17% less likely to either fail to maintain HbA1c <8% or add/switch to a new AHA (HR 0.83, 95% CI: 0.77, 0.90; P<0.001).”

Evidence from this analysis indicated that CANA and GLP-1 agonists have comparable efficacy for attaining and maintaining an HbA1c <8%. However, CANA patients were less likely to discontinue their medication or to add or switch to a new AHA when compared to GLP-1 patients. 

For continuous endocrine news coverage from the AACE 2017 Annual Meeting, check back to MPR's AACE page for the latest updates.