Canagliflozin vs. Sitagliptin: Real-World Weight Loss, Glycemic Control Analysis
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Real-world data indicated that type 2 diabetes patients taking canagliflozin were more likely to meet and maintain HbA1c and weight loss goals vs. patients taking sitagliptin, presented Patrick Lefebvre, MA, from Group d'analyse, Ltee, at the AACE 2017 Annual Meeting.
Study authors aimed to assess glycemic control, weight loss, durability of glycemic control, and the use of other antihyperglycemic drugs in patients initiated on canagliflozin vs. sitagliptin. They identified adults with type 2 diabetes mellitus started on either canagliflozin (n=14,165) or sitagliptin (n=15,528) from the Quintiles IMS Real-World Data Electronic Medical Records between March 29, 2012 to April 30, 2016 or until loss of follow-up. Study outcomes included HbA1c over time (average at 3-month intervals) and time to reaching HbA1c <7%, 8%, 9%; weight loss ≥5%, failure to maintain HbA1c goal; add/switch to a new antihyperglycemic, and the composite of failure to maintain HbA1c goal or add/switch to a new antihyperglycemic.
Lefebvre explained, "HbA1c goals were evaluated among patients with baseline HbA1c above goal. Failure to maintain HbA1c goal was evaluated among patients with baseline HbA1c below goal or who reached goal following index treatment initiation."
The analysis showed mean HbA1c was reduced in both treatment arms but was significantly lower (P<0.01) in the canagliflozin arm vs. sitagliptin arm at each time interval up to 30 months (except 21 months; P=0.18). Patients taking canagliflozin were 12–15% more likely to reach HbA1c <7%, 8%, or 9% (HR 1.12, 95% CI: 1.04, 1.21; P=0.002) and 47% more likely to lose ≥5% of body weight (HR 1.47, 95% CI: 1.40, 1.54; P<0.001) vs. patients taking sitagliptin.
Moreover, canagliflozin-initiated patients were 31% less likely to add or switch to a new antihyperglycemic (HR 0.69, 95% CI: 0.66, 0.72; P<0.001; median time to switch 20.3 months vs. 13.1 months) and 10–15% less likely to fail to maintain their HbA1c goals below threshold (HR 0.85 95% CI: 0.79, 0.92; P<0.001). Overall, researchers calculated that patients taking canagliflozin were 12–16% less likely to fail to maintain goal or add/switch to a new antihyperglycemic (all P<0.01). This suggests inadequate glycemic control on sitagliptin index therapy.
"These findings suggest a higher durability of glycemic control in patients initiated on canagliflozin relative to sitagliptin," concluded Lefebvre.
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