Treatment with canagliflozin 300 mg is associated with a similar hemoglobin A1c (HbA1c) reduction compared with any dose of a glucagon-like peptide-1 (GLP-1) receptor agonist, with better adherence and lower treatment costs, according to study results published in BMJ Open Diabetes Research & Care.
Previous real-world studies have shown that canagliflozin and GLP-1 receptor agonists are associated with similar HbA1c reductions in patients with type 2 diabetes. However, there are no randomized controlled head-to-head clinical trials comparing the efficacy of a sodium-glucose cotransporter 2 (SGLT2) inhibitor vs GLP-1 receptor agonists.
The goal of this study was to assess the glycemic effectiveness, treatment durability, and treatment costs of canagliflozin (300 mg) or any dose of a GLP-1 receptor agonist in adult patients with type 2 diabetes in the United States.
The retrospective administrative claims study included data obtained from the HealthCore Integrated Research Database between April 2012 and February 2017. The primary outcome was HbA1c level at 3-month intervals over a period of 12 months. Furthermore, the data were analyzed to assess achievement of HbA1c thresholds <8.0% and <9.0% and medication costs for patients who were adherent (percentage of days covered ≥80%).
The study included 3171 patients with type 2 diabetes and a claim for canagliflozin 300 mg (n=755; mean age, 54.6 years; 38.0% women) or any dose of GLP-1 receptor agonist (n=2416; mean age, 53.1 years; 52.9% women).
After initiation of canagliflozin 300 mg vs any dose of a GLP-1 receptor agonist, mean HbA1c levels over 12 months of follow-up, measured at 3-month intervals, were similar in both groups.
There was no significant difference in achievement of HbA1c <8.0% with canagliflozin vs any dose of a GLP-1 receptor agonist (51.9% vs 49.7%; P =.666). However, with canagliflozin, patients were less likely to achieve HbA1c <7.0% (27.1% vs 30.4%; hazard ratio [HR], 0.81; 95% CI, 0.68-0.96; P =.016) but more likely to achieve HbA1c <9.0% (69.4% vs 61.9%; HR, 1.24; 95% CI, 1.04-1.48; P =.020) compared with a GLP-1 receptor agonist.
The adherence to medical treatment was greater with canagliflozin compared with treatment with a GLP-1 receptor agonist (47.5% vs 37.5%; P <.0001) and switching medications for diabetes was less common in the group of patients treated with canagliflozin (33.8% vs 38.4%; P =.023). Furthermore, the likelihood of discontinuation of the index medication was lower with canagliflozin treatment compared with GLP-1 receptor agonist treatment (49.6% vs 57.4%; HR, 0.78; 95% CI, 0.70-0.88; P <.0001).
There were no statistically significant differences between the groups treated with canagliflozin vs GLP-1 receptor agonists in treatment durability or treatment failure, defined as HbA1c going above thresholds after having achieved them or receipt of a different antihyperglycemic agent.
The mean annual medication costs were $1421 less with canagliflozin 300 mg vs any dose of a GLP-1 receptor agonist ($3218 vs $4639; P <.001).
The researchers acknowledged several study limitations, including its retrospective design; analyses that focused on canagliflozin only and did not include other SGLT2 inhibitors; initiation of canagliflozin at a high dose and not the standard dose of 100 mg; and limited data on actual use of canagliflozin, as the study was based on prescription claims.
“Initiation of canagliflozin 300 mg versus any dose of a GLP-1 receptor agonist…showed better adherence, less discontinuation, and lower drug acquisition costs compared with initiation of any dose of a GLP-1 receptor agonist,” wrote the researchers. “These findings provide comparative effectiveness data for canagliflozin 300 mg versus any dose of a GLP-1 receptor agonist in the absence of head-to-head clinical trial results and corroborate results from previous real-world studies.”
Disclosure: This study was supported by Janssen Scientific Affairs, LLC. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Singhal M, Tan H, Coleman CI, Han M, Nguyen C, Ingham M. Effectiveness, treatment durability, and treatment costs of canagliflozin and glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes in the USA. BMJ Open Diab Res Care. 2019;7:e000704.