Real-World Clinical Outcomes Associated with Canagliflozin in Patients with Type 2 Diabetes Mellitus in Spain: The Real-Wecan Study

Abstract

The aims of this multicentric retrospective study were to assess in a real-world setting the effectiveness and safety of canagliflozin 100 mg/d (CANA100) as an add-on to the background antihyperglycemic therapy, and to evaluate the intensification of prior sodium–glucose co-transporter type 2 inhibitor (SGLT-2i) therapy by switching to canagliflozin 300 mg/d (CANA300) in patients with T2DM. One cohort of SGLT2i-naïve patients with T2DM who were initiated on CANA100 and a second cohort of patients with prior background SGLT-2i therapy who switched to CANA300 were included in the study. The primary outcome of the study was the mean change in HbA1c over the follow-up time. In total, 583 patients were included—279 in the cohort of CANA100 (HbA1c 8.05%, weight 94.9 kg) and 304 in the cohort of CANA300 (HbA1c 7.51%, weight 92.0 kg). Median follow-up periods in both cohorts were 9.1 and 15.4 months respectively. CANA100 was associated to significant reductions in HbA1c (−0.90%) and weight (−4.1 kg) at the end of the follow-up. In those patients with baseline HbA1c > 8% (mean 9.25%), CANA100 lowered HbA1c levels by 1.51%. In the second cohort, patients switching to CANA300 experienced a significant decrease in HbA1c (−0.35%) and weight (−2.1 kg). In those patients with baseline HbA1c > 8% (mean 8.94%), CANA300 lowered HbA1c levels by 1.12%. There were significant improvements in blood pressure in both cohorts. No unexpected adverse events were reported. In summary, CANA100 (as an add-on therapy) and CANA300 (switching from prior SGLT-2i therapy) significantly improved several cardiometabolic parameters in patients with T2DM.

Real-World Clinical Outcomes Associated with Canagliflozin in Patients Aged 65 Years and Older with Type 2 Diabetes Mellitus in Spain: The Old Real-Wecan Study

“…Our study compared two age groups (230 patients in the older cohort) from the same population with a median follow-up of around a year, in a real setting. Outcomes of our study show that the improvements with CANA100 therapy in glucose control, BP and weight previously described in this same population of patients with T2DM [17], in accordance with other RCT or RWS, are kept in older patients. Even the observation of greater reductions in HbA1c seen among those patients receiving canagliflozin, who had a higher baseline HbA1c, is a feature independent of age.…”

“…This subgroup analysis was based on data from the Real-Wecan study previously described [17]. Briefly, the Real-Wecan study is a multicentric retrospective study whose aims were to assess in a real-world setting the effectiveness and safety of canagliflozin 100 mg/d (CANA100) as an add-on to the background AHAs, and to evaluate the intensification of prior SGLT-2i therapy by switching to canagliflozin 300 mg/d (CANA300) in patients with T2DM.…”

“…We have previously studied in a real-world setting the effectiveness of CANA100 and the switch to CANA300 from prior SGLT-2is in patients with T2DM [17]. In that study, we found significant improvement of several cardiometabolic parameters in patients with T2DM in a real-world setting, with a low incidence of AEs and a high rate of persistence, confirming the results from phase 3 RCTs with CANA100 and obtaining real-life evidence on the effectiveness and safety of switching to CANA300 from a prior SGLT-2i therapy in patients with suboptimal metabolic control.…”

Prevention of Cardiorenal Complications with Sodium–Glucose Cotransporter Type 2 Inhibitors: A Narrative Review

“…Generally, SGLT2i seems to be as effective at decreasing plasma glucose levels as other available therapeutic options [ 11 ]. Although there are real-life studies that suggest differences between SGLT2i [ 12 ], head-to-head comparisons between the different gliflozins are lacking, so it is unknown if any improve glycemic control more than the others. A network meta-analysis showed that SGLT2i as monotherapy were more effective than placebo for lowering HbA1c levels (by 0.59–1.23%) after 24 weeks of treatment [ 13 ].…”

Predictive Factors of Renal Function Decline in Patients with Type 2 Diabetes Treated with Canagliflozin in the Real-Wecan Study

“…In the multicentric observational study Real-WECAN, canagliflozin 100 mg/d (as add-on therapy) and canagliflozin 300 mg/d (switching from canagliflozin 100 mg or other SGLT-2is) were associated with significant improvements in glycemic control, body weight, BP, lipid profile and hepatic biomarkers in patients with T2DM. A significant decrease in the urinary albumin/creatinine ratio (UACR) was found with canagliflozin 100 mg and 300 mg in the subgroup of patients with UACR higher than 30 mg/g Cr, even though there were no meaningful changes in antihypertensive medications during the study [ 5 ].…”