SGLT2 inhibitors, such as Invokana, lower blood sugar levels by causing the kidneys to remove sugar from the body through the urine.
Janssen Pharmaceuticals, Inc.
As anyone who is living with or has a loved one with type 2 diabetes knows, kidney failure is a common complication of the disease. Indeed, diabetes is the most common cause of kidney failure in the United States, according to theÂ American Kidney Fund. But a new study suggests a popular diabetes medication may significantly slow or prevent kidney disease and help protect against major heart-related problems, too.
TheÂ study, published April 14, 2019, in the New England Journal of Medicine, found that people with type 2 diabetes and kidney disease who took Invokana (canagliflozin) were 30 percent less likely to develop kidney failure or die from either kidney failure or cardiovascular disease compared with those taking a placebo.
âKidney disease in diabetes is very common, and people who have this combination are at high risk of kidney failure, heart attack, stroke, heart failure, and death,â says the lead study author,Â Vlado Perkovic, MD, the executive director of the George Institute for Global Health and a professor of medicine at theÂ University of New South Wales in Sydney, Australia. âWe now have a single daily pill available today that can reduce the risk of these complications by about a third. It is a powerful effect that offers a better future for people with diabetes and kidney disease.â
For just over two and a half years on average, Dr. Perkovic and his colleagues followed 4,401 people with type 2 diabetes, age 30 and older, who also had chronic kidney disease. The research randomly chose whether these participants, from 34 countries, received either a daily dose of canagliflozin or a placebo.
The authors observed that among those taking the medication, the risk of kidney failure or death from kidney failure decreased by 34 percent, and the risk of hospitalization for heart failure or death due to cardiac causes dropped by 31 percent.
Those taking the drug were also 20 percent less likely to have heart attack or stroke.
While the U.S. Food and Drug Administration has warned that canagliflozin can increase the chances of having leg and foot amputations and bone fractures, this investigation reported no major differences in these risks between the two groups.
Scientists did comment that the rates of diabetic ketoacidosis were low but higher in the canagliflozin group than in the placebo group. With this life-threatening condition, the body breaks down fat at a rate that is abnormally fast.
Osama Hamdy, MD, PhD, a diabetes specialist and the medical director of the obesity clinical program at the Joslin Diabetes Center in Boston, says that this study contributes to previous research, published in the Journal of Clinical Medicine Research in June 2018,Â showing that similar medications, such as Farxiga (dapagliflozin) and Jardiance (empagliflozin), may provide kidney-protective effects. Dr. Hamdy was not involved in the research.
Diabetes elevates blood sugar levels, which can damage the kidneys and may lead to high blood pressure, which can stretch and weaken kidney blood vessels. These medications, called sodium-glucose cotransporter-2 (SGLT2) inhibitors, lower blood sugar levels by causing the kidneys to remove sugar from the body through the urine. These drugs may be used in combination with other diabetes medicines such as metformin (Glucophage, Glucophage XR, Glumetza, Fortamet, Riomet).
âI think SGLT-2 inhibitors like canagliflozin are game changers in reducing progression of chronic kidney disease and should start earlier with the first manifestation of chronic kidney disease,â saysÂ Hamdy, who regularly prescribes these medications to his patients.
One of the problems with kidney disease, however, is that it often has no symptoms in its early stages and can go undetected until it is very advanced, according to theÂ National Institute of Diabetes and Digestive and Kidney Diseases. That helps explain why about 30 million people or 15 percent of US adults have chronic kidney disease and many donât know it, according to the Centers for Disease Control and Prevention (CDC).
The only way to be sure you have kidney disease is to get tested. The National Kidney Foundation recommends getting examined annually if you have high blood pressure, diabetes, a family history of kidney failure, or if youâre older than 60. The organization also provides a list of possible signs to be aware of.
In an editorial responding to the new research, Julie Ingelfinger, MD, and Clifford Rosen, MD, write that kidney disease treatments such as this are vital as more than 660,000 Americans require intervention for end-stage kidney disease, with 468,000 receiving dialysis (a treatment that purifies the blood; seeÂ MedlinePlus) and more than 193,000 undergoing kidney transplantation.
âThere are potentially long-term cost savings from using a medication such as canagliflozin,â Hamdy says. âDialysis is costly and kidney transplants with subsequent immunosuppressive medications are extremely expensive.â
Dialysis costs an average of $89,000 per patient annually in the United States, according to the Kidney Project at the University of California, San Francisco. Compare that with the cost of Invokana, which Drugs.com estimates can run about $6,000 a year without insurance.
Although camagliflozin is FDA-approved for people with diabetes to lower glucose, it is not yet currently approved for people with moderately reduced kidney function.
âThe results of this study suggest it should be used for people with diabetes and kidney disease for kidney protection,â saysÂ Perkovic. âI hope that the current approvals will be changed to reflect these clear findings.â
He says that individuals with very advanced kidney disease were not included in this investigation, but that this will be addressed in future trials. Hamdy says that the study evaluated patients who already have chronic kidney disease but did not examine the medicationâs effectiveness to prevent chronic kidney disease among those with normal kidney function. The authors note in the study that Janssen, the manufacturer of Invokana, funded the investigation.
âWe now have clear evidence that canagliflozin protects kidney function, and trials are currently assessing whether this is also true for other agents in this class,â says Perkovic.