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Abstract
Dapagliflozin is a sodium glucose co-transporter 2 inhibitor that causes glucose to be lost in the urine. This mechanism of action lowers glucose levels throughout the day and is associated with significant weight loss and moderate blood pressure lowering without increasing heart rate. This class of medications are well tolerated but have a higher incidence of genital tract fungal infections and a slight increase in urinary tract infections that are usually easily treated and not recurrent. Dapagliflozin represents a new medication that should help many individuals with Type 2 diabetes achieve their therapeutic targets.
Financial and competing interests disclosure
V Woo is an advisor and has received speaking honoraria for Astra Zeneca, Boehringer Ingelheim, Lilly, Novo Nordisk and Janssen. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.
Key issues
Cancers were assessed in the clinical trial program, and there was no difference in the incidence of overall cancers.
There was a numerical difference in bladder and breast cancers that is potentially concerning.
The submission to the US FDA was updated in 2013 and there remains an imbalance, although the numbers are improving when comparing dapagliflozin with the comparator.
These will be continued to be monitored in long-term safety studies.
It was also noted in the document that there was no increase in these cancers with canagliflozin and that the findings may be spurious.