Canagliflozin Reduces Renal Failure Risk and Cardiovascular Events in Type 2 Diabetics

Canagliflozin (INVOKANA) reduces the risk of renal failure by a third in people with type 2 diabetes, and kidney disease, while also decreasing the risk of major cardiovascular events, according to the findings of a clinical trial published in The New England Journal of Medicine and presented at the International Society of Nephrology’s World Congress of Nephrology in Melbourne.

Over the last two decades, physicians have mainly depended on renin-angiotensin-aldosterone (RAAS) blockers to avert the progression of kidney disease in diabetic patients, and although this modality has shown some success (particularly with lowering blood pressure), patients undergoing this treatment still incur a high risk of mortality due to renal failure and cardiovascular disease. Researchers for this trial were optimistic that canagliflozin, which increases the excretion of glucose through the kidneys, presented a potential solution.

“For the first time in 18 years, we have a therapy for patients with type 2 diabetes and chronic kidney disease that decreases kidney failure,” said Kenneth Mahaffey, MD, a professor of medicine at the Stanford University School of Medicine and co-principal investigator of the trial, in a press release. “Now, patients with diabetes have a promising option to guard against one of the most severe risks of their condition.”

Mitigated Mortality Rates, Early Stoppage

The trial population included 4,401 participants from 34 countries. Patients were randomly assigned to receive canagliflozin 100 mg daily, while the other control group received a placebo. The trial was stopped early after a planned interim analysis determined efficacy in patients taking canagliflozin.

The results suggested that participants in the canagliflozin group were 30% less likely than those in the placebo group to develop kidney failure or die from as the result of cardiovascular disease or renal failure. The risk of kidney failure or death from renal failure of cardiovascular disease decreased by 34% among the canagliflozin participants, and the risk of hospitalization for heart failure or mortality associated with cardiac issues reduced by 31% in the canagliflozin group.

“People with diabetes and kidney disease are at extremely high risk of kidney failure, heart attack, stroke and death,” added lead author Vlado Perkovic, MBBS, PhD, executive director of The George Institute for Global Health Australia, professor of medicine at the University of New South Wales in Sydney, in a press statement. “With this definitive trial result, we now have a very effective way to reduce this risk using a once-daily pill.”

As type 2 diabetes rates are estimated to rise by 20% to 510 million affected by 2030, Dr. Mahaffey said that a “drug like canagliflozin that improves both cardiovascular and renal outcomes has been eagerly sought by both patients with type 2 diabetes and clinicians caring for them.”