Canagliflozin linked to lower HbA1c levels in younger patients

BOSTON – The effects of canagliflozin on hemoglobin A_1c levels were greater in participants under age 65 years in randomized clinical trials of the SGLT2 inhibitor, according to results of a prespecified subgroup analysis.

Some cardiovascular, renal, and mortality outcomes also varied by age group, according to the analysis of participants in the CANVAS (Canagliflozin Cardiovascular Assessment Study) program. Despite those differences, the effect of canagliflozin was generally consistent on other outcomes, such as body weight and blood pressure, in patient grouped into those aged less than 65 years and those aged 65 years and older, investigators reported at the annual meeting of the American Association of Clinical Endocrinologists.

Nonfatal MI, nonfatal stroke, and the composite of doubling of serum creatine, end-stage renal disease, or renal death were lower in study participants aged 65 and older on canagliflozin. Lower risks of cardiovascular death and all-cause mortality were seen in participants under age 65 years who were taking canagliflozin. However, “these results should be interpreted with caution given the large number of subgroup analyses performed,” wrote Fernando Ovalle, MD, director of the multidisciplinary comprehensive diabetes clinic at the University of Alabama at Birmingham, and his colleagues.

Canagliflozin was found to reduce risk of the composite endpoint of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke versus placebo in previously published results of the CANVAS study, which included individuals with type 2 diabetes mellitus who either had or were at high risk for having cardiovascular disease.

The two multicenter, randomized, controlled trials, CANVAS and CANVAS-R, included more than 10,000 patients. The subgroup analysis presented here at the AACE meeting included 5,578 patients aged less than 65 years (55%) and 4,564 patients aged 65 years or older (45%).

The subgroup analysis found that placebo-subtracted differences in HbA1c were greater in patients under 65 years than those in patients 65 or older (–0.7% and –0.5%, respectively; P less than .0001). However, there were no significant differences by age group in body weight changes, systolic blood pressure, or diastolic blood pressure.

 

Patients aged 65 years or older at baseline had a lower risk of nonfatal MI and nonfatal stroke with canagliflozin versus placebo (P for heterogeneity, .02 and.01, respectively), according to investigators. Older patients also had lower risk of the composite of serum creatinine doubling, end-stage kidney disease, or renal death with canagliflozin versus placebo (P = .01).

Patients aged less than 65 years at baseline had lower risk of cardiovascular death (P = .01) and all cause mortality (P = .01) for canagliflozin versus placebo.

Dr. Ovalle reported disclosures related to Merck, AstraZeneca, Sanofi Pasteur, Novo Nordisk, GlaxoSmithKline, Janssen, Eli Lilly, Medtronic, Pfizer, and GI Dynamics, along with the National Institutes of Health and Juvenile Diabetes Research Foundation.

SOURCE: Ovalle F et al. AACE 2018, Abstract 233.

BOSTON – The effects of canagliflozin on hemoglobin A_1c levels were greater in participants under age 65 years in randomized clinical trials of the SGLT2 inhibitor, according to results of a prespecified subgroup analysis.

Some cardiovascular, renal, and mortality outcomes also varied by age group, according to the analysis of participants in the CANVAS (Canagliflozin Cardiovascular Assessment Study) program. Despite those differences, the effect of canagliflozin was generally consistent on other outcomes, such as body weight and blood pressure, in patient grouped into those aged less than 65 years and those aged 65 years and older, investigators reported at the annual meeting of the American Association of Clinical Endocrinologists.

Nonfatal MI, nonfatal stroke, and the composite of doubling of serum creatine, end-stage renal disease, or renal death were lower in study participants aged 65 and older on canagliflozin. Lower risks of cardiovascular death and all-cause mortality were seen in participants under age 65 years who were taking canagliflozin. However, “these results should be interpreted with caution given the large number of subgroup analyses performed,” wrote Fernando Ovalle, MD, director of the multidisciplinary comprehensive diabetes clinic at the University of Alabama at Birmingham, and his colleagues.

Canagliflozin was found to reduce risk of the composite endpoint of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke versus placebo in previously published results of the CANVAS study, which included individuals with type 2 diabetes mellitus who either had or were at high risk for having cardiovascular disease.

The two multicenter, randomized, controlled trials, CANVAS and CANVAS-R, included more than 10,000 patients. The subgroup analysis presented here at the AACE meeting included 5,578 patients aged less than 65 years (55%) and 4,564 patients aged 65 years or older (45%).

The subgroup analysis found that placebo-subtracted differences in HbA1c were greater in patients under 65 years than those in patients 65 or older (–0.7% and –0.5%, respectively; P less than .0001). However, there were no significant differences by age group in body weight changes, systolic blood pressure, or diastolic blood pressure.

 

Patients aged 65 years or older at baseline had a lower risk of nonfatal MI and nonfatal stroke with canagliflozin versus placebo (P for heterogeneity, .02 and.01, respectively), according to investigators. Older patients also had lower risk of the composite of serum creatinine doubling, end-stage kidney disease, or renal death with canagliflozin versus placebo (P = .01).

Patients aged less than 65 years at baseline had lower risk of cardiovascular death (P = .01) and all cause mortality (P = .01) for canagliflozin versus placebo.

Dr. Ovalle reported disclosures related to Merck, AstraZeneca, Sanofi Pasteur, Novo Nordisk, GlaxoSmithKline, Janssen, Eli Lilly, Medtronic, Pfizer, and GI Dynamics, along with the National Institutes of Health and Juvenile Diabetes Research Foundation.

SOURCE: Ovalle F et al. AACE 2018, Abstract 233.

BOSTON – The effects of canagliflozin on hemoglobin A_1c levels were greater in participants under age 65 years in randomized clinical trials of the SGLT2 inhibitor, according to results of a prespecified subgroup analysis.

Some cardiovascular, renal, and mortality outcomes also varied by age group, according to the analysis of participants in the CANVAS (Canagliflozin Cardiovascular Assessment Study) program. Despite those differences, the effect of canagliflozin was generally consistent on other outcomes, such as body weight and blood pressure, in patient grouped into those aged less than 65 years and those aged 65 years and older, investigators reported at the annual meeting of the American Association of Clinical Endocrinologists.

Nonfatal MI, nonfatal stroke, and the composite of doubling of serum creatine, end-stage renal disease, or renal death were lower in study participants aged 65 and older on canagliflozin. Lower risks of cardiovascular death and all-cause mortality were seen in participants under age 65 years who were taking canagliflozin. However, “these results should be interpreted with caution given the large number of subgroup analyses performed,” wrote Fernando Ovalle, MD, director of the multidisciplinary comprehensive diabetes clinic at the University of Alabama at Birmingham, and his colleagues.

Canagliflozin was found to reduce risk of the composite endpoint of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke versus placebo in previously published results of the CANVAS study, which included individuals with type 2 diabetes mellitus who either had or were at high risk for having cardiovascular disease.

The two multicenter, randomized, controlled trials, CANVAS and CANVAS-R, included more than 10,000 patients. The subgroup analysis presented here at the AACE meeting included 5,578 patients aged less than 65 years (55%) and 4,564 patients aged 65 years or older (45%).

The subgroup analysis found that placebo-subtracted differences in HbA1c were greater in patients under 65 years than those in patients 65 or older (–0.7% and –0.5%, respectively; P less than .0001). However, there were no significant differences by age group in body weight changes, systolic blood pressure, or diastolic blood pressure.

 

Patients aged 65 years or older at baseline had a lower risk of nonfatal MI and nonfatal stroke with canagliflozin versus placebo (P for heterogeneity, .02 and.01, respectively), according to investigators. Older patients also had lower risk of the composite of serum creatinine doubling, end-stage kidney disease, or renal death with canagliflozin versus placebo (P = .01).

Patients aged less than 65 years at baseline had lower risk of cardiovascular death (P = .01) and all cause mortality (P = .01) for canagliflozin versus placebo.

Dr. Ovalle reported disclosures related to Merck, AstraZeneca, Sanofi Pasteur, Novo Nordisk, GlaxoSmithKline, Janssen, Eli Lilly, Medtronic, Pfizer, and GI Dynamics, along with the National Institutes of Health and Juvenile Diabetes Research Foundation.

SOURCE: Ovalle F et al. AACE 2018, Abstract 233.