Kidney Week

Abstract: TH-OR039

Canagliflozin in Patients with Type 2 Diabetes and Macroalbuminuria: Data from the CANVAS Program

Session Information

• Diabetic Kidney Disease Trials: Progress Being Made
  October 25, 2018 | Location: 5A, San Diego Convention Center
  Abstract Time: 06:06 PM - 06:18 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

• Perkovic, Vlado, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia

Vlado Perkovic, MBBS, PhD, FASN

• Neuen, Brendon Lange, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia

Brendon Lange Neuen,

• Ohkuma, Toshiaki, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia

Toshiaki Ohkuma,

• Neal, Bruce, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia

Bruce Neal,

• Matthews, David R., Oxford Centre for Diabetes, Endocrinology and Metabolism and Harris Manchester College, University of Oxford, Oxford, United Kingdom

David R. Matthews,

• de Zeeuw, Dick, University of Groningen, University Medical Center Groningen, Groningen, Netherlands

Dick de Zeeuw,

• Mahaffey, Kenneth W., Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, California, United States

Kenneth W. Mahaffey,

• Fulcher, Greg, The Royal North Shore Hospital, University of Sydney, St. Leonards, New South Wales, Australia

Greg Fulcher,

• Oh, Richard, Janssen Research & Development, LLC, Raritan, New Jersey, United States

Richard Oh,

• Li, Qiang, The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia

Qiang Li,

• Jardine, Meg J., The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia

Meg J. Jardine,

Background

High levels of albuminuria are associated with increased progressive loss of kidney function in type 2 diabetes mellitus (T2DM). SGLT2 inhibitors reduce glomerular hyperfiltration, which might therefore have particular benefits for people with T2DM and macroalbuminuria.

Methods

The CANagliflozin cardioVascular Assessment Study (CANVAS) Program randomized patients with T2DM and a history or high risk of cardiovascular (CV) disease to canagliflozin or placebo. This analysis assessed effects of canagliflozin on renal and CV outcomes in participants with macroalbuminuria at baseline (urinary albumin:creatinine ratio [UACR] >300 mg/g).

Results

The CANVAS Program included 760 participants (7.5%) with macroalbuminuria (mean age 64 y, BP 145/80 mmHg, HbA1c 8.5%, estimated glomerular filtration rate [eGFR] 66 mL/min/1.73 m², median UACR 722 mg/g). As compared with placebo, canagliflozin significantly reduced the geometric mean UACR (change from baseline to end of follow-up –36%, 95% CI –43 to –28); slowed the chronic annual decline in eGFR: –1.76 mL/min/1.73 m² with canagliflozin vs. –4.77 mL/min/1.73 m² with placebo (difference 3.01 mL/min/1.73 m², 95% CI 2.03-3.99); and reduced the risk of the composite outcome of end-stage kidney disease or renal death in combination with either 40% decrease in eGFR or doubling of serum creatinine (Figure). Canagliflozin also reduced the risk of all-cause mortality (Figure), while effects on CV outcomes were broadly consistent with those previously reported for the overall trial population.

Conclusion

Canagliflozin lowers albuminuria and improves outcomes in patients with T2DM and macroalbuminuria.

Funding

• Commercial Support – Janssen Research & Development, LLC