Quality goal attainment and maintenance in patients with type II diabetes mellitus initiated on canagliflozin or a glucagon-like peptide-1 receptor agonist in an actual practice setting

Abstract

Objective: To compare achievement of quality goals (HbA1c, weight loss/body mass index [BMI], systolic blood pressure [SBP]), including maintaining HbA1c, between patients with type 2 diabetes mellitus (T2DM) treated with canagliflozin 300 mg (CANA) or a GLP-1 in an actual practice setting.

Methods: Adults with T2DM newly initiated on CANA or a GLP-1 were identified from the IQVIA^TM Real-World Data Electronic Medical Records–US database (2012Q2–2016Q1). To account for differences in baseline characteristics, inverse probability of treatment weighting was used. Outcomes were compared using Cox models (hazard ratios [HRs] and 95% confidence intervals [CIs]) and Kaplan-Meier analyses.

Results: CANA (n = 11,435) and GLP-1 (n = 11,582) cohorts had similar attainment of HbA1c < 8.0% (64 mmol/mol) and HbA1c < 9.0% (75 mmol/mol; HbA1c < 8.0%: HR [CI] = 0.98 [0.91–1.06]; HbA1c < 9.0%: HR [CI] = 1.02 [0.93–1.12]), while GLP-1 patients were 10% more likely to achieve HbA1c < 7.0% (53 mmol/mol). CANA and GLP-1 patients were similar in maintaining HbA1c < 7.0%, < 8.0%, or <9.0%, achieving weight loss ≥5% (HR [CI] = 1.05 [0.99–1.12]), achieving BMI <30 kg/m² (HR [CI] = 1.11 [0.98–1.27]), and achieving SBP <140 mmHg (HR [CI] = 1.07 [0.98–1.17]). CANA patients were 30% less likely to discontinue treatment, 28% less likely to have a prescription for a new anti-hyperglycemic, and 17–21% less likely to fail to maintain HbA1c < 8.0% or 9.0% or have a prescription for a new anti-hyperglycemic (composite outcome) vs GLP-1. No significant difference was observed for the composite outcome using the HbA1c < 7.0% threshold.

Conclusions: This retrospective study in an actual practice setting showed that CANA patients were generally as likely as GLP-1 patients to achieve HbA1c, weight, and blood pressure thresholds, and to maintain glycemic control while being less likely to discontinue treatment and/or have a new anti-hyperglycemic prescribed.

Keywords:

• Canagliflozin
• type 2 diabetes mellitus
• glucagon-like peptide 1-receptor agonists
• HbA1c
• weight
• blood pressure
• persistence

Transparency

Declaration of funding

This paper was funded by Janssen Scientific Affairs, LLC.

Declaration of financial/other interests

DP, MHL, BE, RK, and PL are employees of Analysis Group, Inc., a consulting company that has received research grants from Janssen Scientific Affairs, LLC, to conduct this study. MI and MP are employees and stockholders of Janssen Scientific Affairs, LLC. CW is a paid consultant for Abbott, Astra Zeneca, Boehringer Ingelheim, Janssen Scientific Affairs, LLC, Novo Nordisk, and Sanofi, and is on the speaker’s bureau for Astra Zeneca, Boehringer Ingelheim, Eli Lilly, Insulet, Janssen Scientific Affairs, LLC, Novo Nordisk, Sanofi. Peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no other relevant financial relationships to disclose.

Acknowledgments

Writing assistance was kindly provided by Federica Torres Sakai from Analysis Group, Inc.