Why choose Invokana (canagliflozin) - After first line, take a firm line
Invokana vs DPP4i & Other SGLT2i Icon

vs DPP4i & Other SGLT2i

Invokana vs sitagliptin (DPP4 inhibitor)

  • Invokana is the only SGLT2 inhibitor with a proven efficacy profile vs sitagliptin, a DPP4 inhibitor, in dual therapy with metformin and triple therapy with metformin and sulphonylurea. 1,2
  • Invokana 300mg demonstrated superior HbA1c reductions vs sitagliptin as an add-on to metformin. 1

  • Significantly greater and sustained reductions in systolic BP were observed with Invokana vs sitagliptin, as an add-on to metformin at 52 weeks. 1
  • Invokana 100mg and 300mg led to statistically significant reductions in body weight compared with sitagliptin, as an add-on to metformin, at 52 weeks. 1

Invokana vs other SGLT2 inhibitors

  • Although no head to head studies of SGLT2 inhibitors have been completed, network meta-analyses (NMAs) allow indirect comparisons to be made:
  • ‘Methodology: Relative effects between SGLT2 inhibitors for the proportion of patients achieving HbA1c <7.0% were estimated from a Bayesian NMA of clinical trials reporting data for triple therapy with metformin plus sulphonylurea. Odds ratios and Bayesian pairwise probabilities (i.e. the probability to perform better) for comparisons of canagliflozin 300 and 100mg versus empagliflozin 25 and 10mg and dapagliflozin 10mg were estimated.’ 2
  • Patients treated with Invokana 100mg had similar predicted odds of reaching HbA1c <53mmol/mol (<7%) compared with dapagliflozin 10mg and empagliflozin 25mg (OR, 1.12 [P=60%] and 0.94 [P=44%]), respectively, and higher predicted odds vs empagliflozin 10mg (OR, 1.26 [P=73%]). 2
  • Patients treated with Invokana 300mg had higher predicted odds of reaching HbA1c <53mmol/mol (<7%) vs dapagliflozin 10mg and empagliflozin 25mg and 10mg (OR, 2.03 [P=94%], 1.71 [P=93%], and 2.29 [P=99%], respectively). 2
  • Starting from similar baseline HbA1c levels, the predicted odds of patients achieving HbA1c <53mmol/mol (<7%) over 26 weeks were greater for Invokana 300mg (41% of patients, 95% credibility interval [CrI]: 31%, 51%) than for other SGLT2 inhibitors. 2
  • The cost per patient of achieving the HbA1c target of <53mmol/mol (<7%) over 26 weeks was lowest for Invokana 300mg compared with other SGLT2 inhibitors, due to the greater HbA1c response. 2
  • ‘Methodology: A systematic literature review and Bayesian NMA was conducted using absolute differences and Bayesian pairwise probabilities to estimate the relative efficacy. The aim was to evaluate the relative efficacy of canagliflozin in lowering HbA1c compared to other antihyperglycaemic agents as add-on to metformin plus sulphonylurea at 26 ± 4 weeks.’
  • As an add-on to metformin plus sulphonylurea, estimated HbA1c point reductions at 26 weeks were greater for Invokana 300mg, and at least as large for Invokana 100mg, compared with other SGLT2 inhibitors. 3
  • ‘Methodology: In an independent NMA using a frequentist model, pairwise random-effects were performed to estimate study variance. The aim of this NMA, which reviewed 38 trials involving 23,997 patients, was to assess the comparative safety and efficacy of SGLT-2 inhibitors in treating hyperglycaemia in adults with T2DM.’
  • Invokana 300mg is associated with greater reductions in HbA1c compared with other SGLT2 inhibitors at any dose. 4

Clinical effectiveness

  • Invokana gets more patients to target than any other SGLT2i as add-on to metformin.
Clinical effectiveness of SGLT2i's achieving HbA1c
  • 58% of patients given Invokana 300mg in addition to metformin achieve the 7% HbA1c target. 6

This is not a head-to-head study, figures taken from respective Summary of Product Characteristics.

Reduction in HbA1c with SGLT2i’s, metformin, DPP4i’s and sulphonylureas vs placebo 7

  • Head to head studies are not available for all drug combinations, network meta-analyses (NMA) allow indirect treatment comparisons to be made.
Reduction in HbA1c with SGLT2i’s, metformin, DPP4i’s and sulphonylureas vs placebo - Invokana (canagliflozin) Chart

Adapted from Zaccardi F et al. 2016 7

Methodology: In an independent NMA using a frequentist model, pairwise random-effects analyses were performed to estimate study variance.
The aim of this NMA, which reviewed 38 trials involving 23,997 patients, was to assess the comparative safety and efficacy of SGLT2i’s in adults with T2DM.

References
  1. Lavalle-González FJ et al. Diabetologia 2013;56(12):2582-92
  2. Evans M et al. Cost of glycaemic target achievement with sodium glucose co-transporter 2 inhibitors in patients with type 2 diabetes in the UK. Diabetes Ther 2017;8(5):1175-1185
  3. Schroeder M et al. A network meta-analysis to assess options for treatment intensification for patients with type 2 diabetes inadequately controlled on dual therapy. Poster presented at EASD, September 14–18, 2015. Stockholm, Sweden
  4. Empagliflozin Summary of Product Characteristics. Boehringer Ingelheim, 2018
  5. Dapagliflozin Summary of Product Characteristics. AstraZeneca, 2018
  6. Invokana Summary of Product Characteristics. Napp Pharmaceuticals, 2018
  7. Zaccardi F et al. Diabetes Obes Metab 2016;18(8):783–794