Diabetic Ketoacidosis and Related Events in the Canagliflozin Type 2 Diabetes Clinical Program

Ngozi Erondu, Mehul Desai, Kirk Ways, Gary Meininger, Ngozi Erondu, Mehul Desai, Kirk Ways, Gary Meininger

Abstract

Objective: This study assessed the incidence of serious adverse events of diabetic ketoacidosis (DKA) among patients with type 2 diabetes treated with canagliflozin.

Research design and methods: All serious adverse events of DKA and related events (ketoacidosis, metabolic acidosis, and acidosis) from 17,596 patients from randomized studies of canagliflozin through 11 May 2015 were analyzed.

Results: Serious adverse events of DKA and related events were reported in 12 patients (0.07%), including 4 (0.07%), 6 (0.11%), and 2 (0.03%) treated with canagliflozin 100 and 300 mg and comparator, respectively; corresponding incidence rates were 0.522, 0.763, and 0.238 per 1,000 patient-years, respectively. Most patients with DKA and related events had a blood glucose >300 mg/dL (16.7 mmol/L) at presentation of DKA, were on insulin, and had DKA-precipitating factors, including some with type 1 diabetes/latent autoimmune diabetes of adulthood.

Conclusions: DKA and related events occurred at a low frequency in the canagliflozin type 2 diabetes program, with an incidence consistent with limited existing observational data in the general population with type 2 diabetes.

© 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

References

    1. U.S. Food and Drug Administration. FDA drug safety communication: FDA warns that SGLT2 inhibitors for diabetes may result in a serious condition of too much acid in the blood [article online], 2015. Available from . Accessed 19 May 2015
    1. Hine J, Paterson H, Abrol E, Russell-Jones D, Herring R. SGLT inhibition and euglycaemic diabetic ketoacidosis. Lancet Diabetes Endocrinol 2015;3:503–504
    1. Hayami T, Kato Y, Kamiya H, et al. . Case of ketoacidosis by a sodium-glucose cotransporter 2 inhibitor in a diabetic patient with a low-carbohydrate diet. J Diabetes Investig 20 February 2015 [E-pub ahead of print]. DOI: 10.1111/jdi.12330
    1. Burr K, Nguyen A-T, Rasouli N. A case report of ketoacidosis associated with canagliflozin (Invokana). Late-breaking abstract presented at the Endocrine Society's 97th Annual Meeting & Expo, 5–8 March 2015, San Diego, CA
    1. Wang ZH, Kihl-Selstam E, Eriksson JW. Ketoacidosis occurs in both type 1 and type 2 diabetes--a population-based study from Northern Sweden. Diabet Med 2008;25:867–870
    1. Ferrannini E, Muscelli E, Frascerra S, et al. . Metabolic response to sodium-glucose cotransporter 2 inhibition in type 2 diabetic patients. J Clin Invest 2014;124:499–508
    1. Merovci A, Solis-Herrera C, Daniele G, et al. . Dapagliflozin improves muscle insulin sensitivity but enhances endogenous glucose production. J Clin Invest 2014;124:509–514
    1. Bonner C, Kerr-Conte J, Gmyr V, et al. . Inhibition of the glucose transporter SGLT2 with dapagliflozin in pancreatic alpha cells triggers glucagon secretion. Nat Med 2015;21:512–517
    1. Wilding JP, Charpentier G, Hollander P, et al. . Efficacy and safety of canagliflozin in patients with type 2 diabetes mellitus inadequately controlled with metformin and sulphonylurea: a randomised trial. Int J Clin Pract 2013;67:1267–1282
    1. Yale JF, Bakris G, Cariou B, et al. . Efficacy and safety of canagliflozin in subjects with type 2 diabetes and chronic kidney disease. Diabetes Obes Metab 2013;15:463–473
    1. Yale JF, Bakris G, Cariou B, et al. .; DIA3004 Study Group . Efficacy and safety of canagliflozin over 52 weeks in patients with type 2 diabetes mellitus and chronic kidney disease. Diabetes Obes Metab 2014;16:1016–1027
    1. Stenlöf K, Cefalu WT, Kim KA, et al. . Efficacy and safety of canagliflozin monotherapy in subjects with type 2 diabetes mellitus inadequately controlled with diet and exercise. Diabetes Obes Metab 2013;15:372–382
    1. Stenlöf K, Cefalu WT, Kim KA, et al. . Long-term efficacy and safety of canagliflozin monotherapy in patients with type 2 diabetes inadequately controlled with diet and exercise: findings from the 52-week CANTATA-M study. Curr Med Res Opin 2014;30:163–175
    1. Lavalle-González FJ, Januszewicz A, Davidson J, et al. . Efficacy and safety of canagliflozin compared with placebo and sitagliptin in patients with type 2 diabetes on background metformin monotherapy: a randomised trial. Diabetologia 2013;56:2582–2592
    1. Neal B, Perkovic V, de Zeeuw D, et al. . Rationale, design, and baseline characteristics of the CANagliflozin cardioVascular Assessment Study (CANVAS)—a randomized placebo-controlled trial. Am Heart J 2013;166:217–223.e11
    1. Neal B, Perkovic V, de Zeeuw D, et al. .; CANVAS Trial Collaborative Group . Efficacy and safety of canagliflozin, an inhibitor of sodium-glucose cotransporter 2, when used in conjunction with insulin therapy in patients with type 2 diabetes. Diabetes Care 2015;38:403–411
    1. Cefalu WT, Leiter LA, Yoon KH, et al. . Efficacy and safety of canagliflozin versus glimepiride in patients with type 2 diabetes inadequately controlled with metformin (CANTATA-SU): 52 week results from a randomised, double-blind, phase 3 non-inferiority trial. Lancet 2013;382:941–950
    1. Leiter LA, Yoon KH, Arias P, et al. . Canagliflozin provides durable glycemic improvements and body weight reduction over 104 weeks versus glimepiride in patients with type 2 diabetes on metformin: a randomized, double-blind, phase 3 study. Diabetes Care 2015;38:355–364
    1. Bode B, Stenlöf K, Sullivan D, Fung A, Usiskin K. Efficacy and safety of canagliflozin treatment in older subjects with type 2 diabetes mellitus: a randomized trial. Hosp Pract (1995) 2013;41:72–84
    1. Bode B, Stenlöf K, Harris S, et al. . Long-term efficacy and safety of canagliflozin over 104 weeks in patients aged 55-80 years with type 2 diabetes. Diabetes Obes Metab 2015;17:294–303
    1. Forst T, Guthrie R, Goldenberg R, et al. . Efficacy and safety of canagliflozin over 52 weeks in patients with type 2 diabetes on background metformin and pioglitazone. Diabetes Obes Metab 2014;16:467–477
    1. Schernthaner G, Gross JL, Rosenstock J, et al. . Canagliflozin compared with sitagliptin for patients with type 2 diabetes who do not have adequate glycemic control with metformin plus sulfonylurea: a 52-week randomized trial. Diabetes Care 2013;36:2508–2515
    1. Qiu R, Capuano G, Meininger G. Efficacy and safety of twice-daily treatment with canagliflozin, a sodium glucose co-transporter 2 inhibitor, added on to metformin monotherapy in patients with type 2 diabetes mellitus. J Clin Transl Endocrinol 2014;1:54–60
    1. Rosenstock J, Chuck L, González-Ortiz M, et al. . Initial combination therapy with canagliflozin (CANA) plus metformin extended-release (MET XR) in drug-naïve type 2 diabetes mellitus (T2DM) (Abstract) Diabetes 2015;64:LB34

Source: PubMed

3
Předplatit