Canagliflozin for the treatment of type 2 diabetes: a comparison between Japanese and non-Japanese patients

Abstract

Canagliflozin, a sodium-glucose co-transporter-2 (SGLT2) inhibitor, improves various cardiometabolic parameters. Although canagliflozin was originally discovered in Japan, no comprehensive summary of its effects in Japanese patients has been reported. As differences exist in the pathologic features of diabetes between Japanese and non-Japanese populations, it is important to consolidate Japanese data for canagliflozin. Areas covered: The authors summarize Japanese clinical trial and post-marketing surveillance data for canagliflozin, and make comparisons with non-Japanese data. They also consider the therapeutic potential of canagliflozin in Japanese patients by presenting results from the CANagliflozin cardioVascular Assessment Study (CANVAS) Program. Expert opinion: In Japanese patients, canagliflozin 100 mg, administered as monotherapy or combination therapy, improved blood glucose, body weight, and blood pressure, and was well tolerated; the efficacy and safety profiles were comparable to previous clinical studies in other countries. In the CANVAS Program, canagliflozin reduced major cardiovascular events, and although Japan was not included in this program, canagliflozin may have cardiovascular benefits in Japanese patients, in whom control of multiple risk factors is important for preventing diabetic complications. Patients with high cardiovascular risk often have multiple comorbidities, so it is important to consider the risk-benefit balance of using SGLT2 inhibitors in individual patients.

The Unique Pharmacological and Pharmacokinetic Profile of Teneligliptin: Implications for Clinical Practice

“…Owing to the differences in their mechanisms of action, teneligliptin and canagliflozin act in a complementary manner. Body weight management is important for maintaining good long-term glycemic control with DPP-4 inhibitors [ 92 , 93 ], and the SGLT2 inhibitor canagliflozin reduces not only blood glucose but also body weight [ 94 ]; thus, the FDC of teneligliptin/canagliflozin also represents a useful therapeutic option for T2DM patients, with additional benefits such as adherence.…”

Impact of body mass index on the efficacy and safety of ipragliflozin in Japanese patients with type 2 diabetes mellitus: A subgroup analysis of 3‐month interim results from the Specified Drug Use Results Survey of Ipragliflozin Treatment in Type 2 Diabetic Patients: Long‐term Use study

“…Although there are limited data for ipragliflozin outside of Asia, the effects of other SGLT2 inhibitors (e.g., canagliflozin) have been studied in detail. For example, a recent review by Inagaki et al . concluded that canagliflozin had similar efficacy and safety profiles in Japanese and non‐Japanese patients.…”

Transcultural Diabetes Care in The United States – A Position Statement by the American Association of Clinical Endocrinologists

“…Among clinical trials, post hoc analysis of the EMPA-REG and CANVAS clinical trials show that empagliflozin had more cardiovascular benefits in Asians than canagliflozin (in contrast, African Americans had greater cardiovascular benefits with canagliflozin) (257). However, in multiple clinical studies, and notwithstanding a theoretical advantage of glucose-lowering in Asians (who may have more of a b-cell impairment), there were similar clinical efficacy and safety data results with sodium-glucose cotransporter-2 inhibitor (SGLT2i) use among Asians, Caucasians, African Americans/Blacks, and other racial groups (258)(259)(260)(261)(262)(263). In a pharmacogenomics study involving Taiwanese patients with T2D, there were 45 gene variants associated with therapeutic responses to dipeptidyl peptidase-4 inhibitors, with an affirmation that b-cell dysfunction plays more of an etiologic role than insulin resistance in Asians (264).…”