Invokana (canagliflozin) use was found to be superior when compared with dipeptidyl peptidase-4 (DPP-4) inhibitors for reducing A1C, increasing treatment adherence, and was shown to improve results when used as an add-on therapy to metformin and sitagliptin.
The findings are based on a number of newly published studies, which include retrospective real world (RW) analyses of insurance claims and laboratory data, and also randomized control trials (RTCs).
Results from one real world study showed that the average reduction in A1C was greater with Invokana than sitagliptin, 0.93% compared with 0.57%, respectively (P=0.004). Data for this comparison was taken from the large U.S. insurance claims database, Optum, which included commercial and Medicare Advantage members with type 2 diabetes and use of Invokana or sitagliptin.
Using propensity scores, the patients in each RW comparison study were matched based on demographics and initial characteristics.
In a separate analysis using Truven Health Analytics MarketScan database, more patients were shown to persist with Invokana than other therapies. Over a 9 month period (February 2014 to October 2014), which included 38,083 patients, there was 66% persistence with Invokana, compared to 46% with dapagliflozin, 47 – 53% with DPP-4 inhibitors, and 26 – 50% with GLP-1 receptor agonists.
In a 26-week, randomized, double-blind study, Invokana as an add-on therapy to metformin and sitagliptin was shown to achieve treatment goals to a greater degree than placebo. This included reducing A1C levels to <7% in 32.3% of Invokana patients vs. 12.2% in the placebo group (P=0.002). Blood pressure reductions to 140/90mmHg and 130/80mmHg were also greater with Invokana than placebo; 86.5% vs 78.3% and 54.2% vs. 32.5%, respectively. The Invokana dose was titrated from 100mg to 300mg during the trial for 85.4% of patients who showed adequate kidney function.
In another RW study, using data from the HealthCore Integrated Research Database, analysis showed that Invokana was associated with a reduction of 0.8% in A1C after 12 months of treatment (baseline average was 8.4%). For all patients with a baseline A1C ≥7%, the reduction was 1% after 12 months. This study included 881 patients with an average age of 55 years.
The above studies were presented at the 76th scientific sessions of the American Diabetes Association. For more information visit Diabetes.org.