Type 2 diabetes drug canagliflozin shows lower heart risk but greater amputations

The type 2 diabetes drug canagliflozin (marketed as Invokana) is associated with a lower risk of heart attacks and stroke but increased risk of amputation, new research shows.
The new data comes from two separate trials and was presented at the American Diabetes Association (ADA) 2017 Scientific Sessions.
The Canagliflozin Cardiovascular Assessment Study (CANVAS) looked at effects of the drug on heart disease and stroke risks. The CANVAS renal-end-points trial (CANVAS-R) looked at the effects on kidney disease risks.
The Australian study involved 10,000 people with type 2 diabetes who were randomly assigned to receive canagliflozin or placebo for an average of 188 weeks.
The findings suggested canagliflozin reduced the risk of cardiovascular disease by 14 per cent and also lowered the risk of hospitalisation relating to heart failure by 33 per cent.
Canagliflozin becomes the second SGLT2 inhibitor drug to show a benefit in heart disease risk. Last year, empagliflozin (marketed as Jardiance) became the first diabetes drug to demonstrate a benefit on heart health.
Lead researcher Professor Bruce Neal, from the George Institute for Global Health, said: “Coronary heart disease is the biggest killer by far for people with type 2 diabetes. Our findings suggest that not only does canagliflozin significantly reduce the risk of heart disease, it also has many other benefits too. We found it also reduced blood pressure and led to weight loss.”
The results showed that users of canagliflozin had decreased risk related to kidney disease, however, the benefit was not enough to be judged statistically significant. Less positive was a doubling in risk of amputations associated with canagliflozin use.
Prof. Neal added: “We don’t know why there was an increased risk of amputation, and further work is needed in this area.”
The findings of the research have been published in the New England Journal of Medicine.