Effects of canagliflozin on fracture risk in patients with type 2 diabetes mellitus

NB Watts, JP Bilezikian, K Usiskin… - The Journal of …, 2016 - academic.oup.com
NB Watts, JP Bilezikian, K Usiskin, R Edwards, M Desai, G Law, G Meininger
The Journal of Clinical Endocrinology, 2016academic.oup.com
Context: Canagliflozin is a sodium glucose cotransporter 2 inhibitor developed to treat type 2
diabetes mellitus (T2DM). Objective: The purpose of this study was to describe the effects of
canagliflozin on bone fracture risk. Design and Setting: This was a randomized phase 3
study in patients with T2DM. Patients and Interventions: Canagliflozin doses of 100 and 300
mg were evaluated in the overall population of patients from 9 placebo-and active-controlled
studies (N= 10 194), as well as in separate analyses of a single trial enriched with patients …
Context
Canagliflozin is a sodium glucose cotransporter 2 inhibitor developed to treat type 2 diabetes mellitus (T2DM).
Objective
The purpose of this study was to describe the effects of canagliflozin on bone fracture risk.
Design and Setting
This was a randomized phase 3 study in patients with T2DM.
Patients and Interventions
Canagliflozin doses of 100 and 300 mg were evaluated in the overall population of patients from 9 placebo- and active-controlled studies (N = 10 194), as well as in separate analyses of a single trial enriched with patients with a prior history/risk of cardiovascular disease (ie, the CANagliflozin cardioVascular Assessment Study [CANVAS]; N = 4327) and a pooled population of 8 non-CANVAS studies (N = 5867).
Outcome Measures
The incidence of adjudicated fracture adverse events (AEs), fall-related AEs, and volume depletion–related AEs was assessed.
Results
The incidence of fractures was similar with canagliflozin (1.7%) and noncanagliflozin (1.5%) in the pooled non-CANVAS studies. In CANVAS, a significant increase in fractures was seen with canagliflozin (4.0%) vs placebo (2.6%) that was balanced between the upper and lower limbs. The incidence of fractures was higher with canagliflozin (2.7%) vs noncanagliflozin (1.9%) in the overall population, which was driven by the increase of fractures in CANVAS. The incidence of reported fall-related AEs was low, but significantly higher with canagliflozin in CANVAS, potentially related to volume depletion–related AEs, but not significantly different in the pooled non-CANVAS studies and the overall population.
Conclusions
Fracture risk was increased with canagliflozin treatment, driven by CANVAS patients, who were older, with a prior history/risk of cardiovascular disease, and with lower baseline estimated glomerular filtration rate and higher baseline diuretic use. The increase in fractures may be mediated by falls; however, the cause of increased fracture risk with canagliflozin is unknown.
Oxford University Press