Efficacy and safety of replacing sitagliptin with canagliflozin in real-world patients with type 2 diabetes uncontrolled with sitagliptin combined with metformin and/or gliclazide: The SITA-CANA Switch Study

• Published in: Diabetes & metabolism Vol. 44; no. 4; pp. 373 - 375
• Main Authors: Garcia de Lucas, M.D., Pérez Belmonte, L.M., Suárez Tembra, M., Olalla Sierra, J., Gómez Huelgas, R.
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.09.2018
• Subjects: Aged; Blood Glucose - drug effects; Blood pressure; Blood Pressure - drug effects; Body Weight; Canagliflozin; Canagliflozin - adverse effects; Canagliflozin - pharmacology; Canagliflozin - therapeutic use; Diabetes Mellitus, Type 2 - drug therapy; Female; Gliclazide; Gliclazide - adverse effects; Gliclazide - pharmacology; Gliclazide - therapeutic use; Glycated Hemoglobin A - analysis; HbA1c; Humans; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - pharmacology; Hypoglycemic Agents - therapeutic use; Male; Metformin - adverse effects; Metformin - pharmacology; Metformin - therapeutic use; Middle Aged; Retrospective Studies; Sitagliptin; Sitagliptin Phosphate - adverse effects; Sitagliptin Phosphate - pharmacology; Sitagliptin Phosphate - therapeutic use; Weight; Gliclazide; Sitagliptin; Blood pressure; Canagliflozin; HbA1c; Weight
• ISSN: 1262-3636; 1878-1780
• DOI: 10.1016/j.diabet.2018.05.005

To analyze the efficacy and safety of replacing sitagliptin with canagliflozin in patients with type 2 diabetes (T2D) and poor metabolic control despite treatment with sitagliptin in combination with metformin and/or gliclazide. In this multicentre observational, retrospective, 26-week clinical study of patients with T2D and poor glycaemic control (HbA1c: 7.5–9.5%) treated with sitagliptin in combination with metformin and/or gliclazide, sitagliptin (and gliclazide if appropriate) were replaced by canagliflozin. The main outcome of the study was the proportion of patients who achieved good glycaemic control (HbA1c<7%) by the end of the study. The study sample comprised 50 patients (baseline HbA1c 8.0±0.6%) treated with sitagliptin 100mg/day, 14 of whom were also taking gliclazide 60mg/day while 38 were taking metformin 1700mg/day. Sitagliptin treatment was replaced by either canagliflozin 100mg (n=17) or 300mg (n=33). After 26 weeks of follow-up, these patients presented with significant decreases in HbA1c (−1.1%; P<0.000), weight (−3.89kg; P<0.000), BMI (−1.37kg/m2; P<0.022), abdominal circumference (−5.42cm; P<0.004), systolic and diastolic blood pressure (−5.3mmHg and −4.4mmHg, respectively; P=0.005), triglycerides (−42mg/dL; P=0.005) and LDL/HDL cholesterol ratio (−0.34; P=0.005). By the end of the study, 42% of patients had achieved HbA1c levels<7%. In patients with T2D poorly controlled with sitagliptin, whether alone or in combination with metformin and/or gliclazide, replacing it with canagliflozin may be a simple yet effective intensification strategy. Our results, which may have important implications for clinical practice, now need to be confirmed in larger observational studies.