Ongoing canagliflozin treatment beneficial to diabetic patients with CKD

Treatment with the sodium‐glucose cotransporter 2 inhibitor canagliflozin protects against cardiovascular events in patients with comorbid type 2 diabetes (T2D) and chronic kidney disease (CKD), with a larger absolute benefit for total cardiovascular than first cardiovascular events, according to a post hoc analysis.

Researchers used data from the CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) trial, which evaluated canagliflozin against matching placebo in 4,401 patients with T2D albuminuria, and estimated glomerular filtration rate of 30 to <90 mL/min per 1.73 m².

Over a median follow-up of 2.62 years, a total of 883 cardiovascular events occurred in 634 patients. Looking at the entire population, 3,767 (85.6 percent) patients experienced no cardiovascular events, 472 (10.7 percent) had a single event, and 162 (3.7 percent) had at least two events. The maximum number of events experienced by a patient was seven.

Of the 883 cardiovascular events, 634 (72 percent) were first events and 249 (28 percent) were subsequent cardiovascular events. The first, second, and third cardiovascular events were mostly cardiovascular death or hospitalization for heart failure.

In multivariable models, canagliflozin reduced the incidence of first cardiovascular events by 26 percent (hazard ratio, 0.74, 95 percent confidence interval [CI], 0.63–0.86; p<0.001) and total cardiovascular events by 29 percent (incidence rate ratio, 0.71, 95 percent CI, 0.59–0.86; p<0.001).

The absolute risk difference per 1,000 patients treated over 2.5 years was −44 (95 percent CI, −67 to −21) first cardiovascular events and −73 (95 percent CI, −114 to −33) total cardiovascular events.

The present data provide further support for the benefit of continuing canagliflozin therapy after an initial event to prevent subsequent cardiovascular events.