In reply: Canagliflozin

In Reply: I would like to thank these readers very much for their response and comments.

Additional data provided from the study conducted by Lavalle-González et al evaluating the efficacy and safety of canagliflozin (100-mg and 300-mg doses) vs placebo and sitagliptin in patients with type 2 diabetes showed similar findings in weight and blood pressure reduction with slight LDL elevation with the studies mentioned in my article.¹ At 52 weeks, as noted, canagliflozin 100 mg demonstrated noninferiority, and canagliflozin 300 mg showed a statistically significant superiority to sitagliptin in lowering hemoglobin A_1c (a change of −0.73% with canagliflozin 100 mg, −0.88% with canagliflozin 300 mg, and −0.73% with sitagliptin), which may be considered in treatment decisions along with the other possible effects of this drug.¹

The decision to use canagliflozin as second-or third-line therapy should be individualized after considering all of the patient’s risk factors as well as the potential benefit vs side effectsof this drug. Metformin remains my first-line choice in the management of type 2 diabetes. In my clinical practice, thus far, I have not used canagliflozin in patients with known coronary disease or a history of cardiovascular events. I have ensured that the LDL is certainly below goal before starting any patient on this drug, and I have followed the LDL closely, without hesitating to increase the statin drug to keep the LDL below goal. I agree that the slight increase of LDL is of concern, and certainly long-term studies are necessary to see whether there will be any increase in cardiovascular events from the use of canagliflozin.

In Reply: I would like to thank these readers very much for their response and comments.

Additional data provided from the study conducted by Lavalle-González et al evaluating the efficacy and safety of canagliflozin (100-mg and 300-mg doses) vs placebo and sitagliptin in patients with type 2 diabetes showed similar findings in weight and blood pressure reduction with slight LDL elevation with the studies mentioned in my article.¹ At 52 weeks, as noted, canagliflozin 100 mg demonstrated noninferiority, and canagliflozin 300 mg showed a statistically significant superiority to sitagliptin in lowering hemoglobin A_1c (a change of −0.73% with canagliflozin 100 mg, −0.88% with canagliflozin 300 mg, and −0.73% with sitagliptin), which may be considered in treatment decisions along with the other possible effects of this drug.¹

The decision to use canagliflozin as second-or third-line therapy should be individualized after considering all of the patient’s risk factors as well as the potential benefit vs side effectsof this drug. Metformin remains my first-line choice in the management of type 2 diabetes. In my clinical practice, thus far, I have not used canagliflozin in patients with known coronary disease or a history of cardiovascular events. I have ensured that the LDL is certainly below goal before starting any patient on this drug, and I have followed the LDL closely, without hesitating to increase the statin drug to keep the LDL below goal. I agree that the slight increase of LDL is of concern, and certainly long-term studies are necessary to see whether there will be any increase in cardiovascular events from the use of canagliflozin.

In Reply: I would like to thank these readers very much for their response and comments.

Additional data provided from the study conducted by Lavalle-González et al evaluating the efficacy and safety of canagliflozin (100-mg and 300-mg doses) vs placebo and sitagliptin in patients with type 2 diabetes showed similar findings in weight and blood pressure reduction with slight LDL elevation with the studies mentioned in my article.¹ At 52 weeks, as noted, canagliflozin 100 mg demonstrated noninferiority, and canagliflozin 300 mg showed a statistically significant superiority to sitagliptin in lowering hemoglobin A_1c (a change of −0.73% with canagliflozin 100 mg, −0.88% with canagliflozin 300 mg, and −0.73% with sitagliptin), which may be considered in treatment decisions along with the other possible effects of this drug.¹

The decision to use canagliflozin as second-or third-line therapy should be individualized after considering all of the patient’s risk factors as well as the potential benefit vs side effectsof this drug. Metformin remains my first-line choice in the management of type 2 diabetes. In my clinical practice, thus far, I have not used canagliflozin in patients with known coronary disease or a history of cardiovascular events. I have ensured that the LDL is certainly below goal before starting any patient on this drug, and I have followed the LDL closely, without hesitating to increase the statin drug to keep the LDL below goal. I agree that the slight increase of LDL is of concern, and certainly long-term studies are necessary to see whether there will be any increase in cardiovascular events from the use of canagliflozin.