February 04, 2016
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Combination metformin, Invokana reduces HbA1c, body weight

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In drug-naive patients with type 2 diabetes, a combination of Invokana and metformin was more effective than monotherapy with either drug, according to recent findings.

Researchers also found Invokana (canagliflozin, Janssen) monotherapy noninferior to metformin monotherapy.

Julio Rosenstock, MD, director of the Dallas Diabetes and Endocrine Center at Medical City, and colleagues evaluated data from a phase 3 study conducted at 158 centers in 12 countries from May 2013 to December 2014 on 1,186 drug-naive patients (mean age, 54.9 years) with type 2 diabetes (mean duration, 3.3 years) to determine the safety and efficacy of therapy with the sodium-glucose cotransporter 2 inhibitor canagliflozin combined with metformin or monotherapy with each drug.

Participants were randomly assigned 100 mg canagliflozin plus metformin (n = 237), 300 mg canagliflozin plus metformin (n = 237), 100 mg canagliflozin (n = 237), 300 mg canagliflozin (n = 238) or metformin (n = 237).

Greater reductions in HbA1c were found with the combination therapies compared with metformin alone and canagliflozin alone (P = .001 for all). At week 26, compared with metformin alone, more participants had HbA1c less than 7% in the canagliflozin 100 mg plus metformin group (P = .027) and the canagliflozin 300 mg plus metformin group (P = .016). Compared with metformin alone, significant reductions in body weight were found in the combination therapy groups (P = .001 for both).

Serious adverse events were low across all groups ( 3%).

“[Canagliflozin 100 mg] and [canagliflozin 300 mg] in combination with [metformin] provided significantly greater reductions in HbA1c and body weight compared with monotherapy with [metformin], [canagliflozin 100 mg] or [canagliflozin 300 mg], with a tolerability profile consistent with the respective monotherapies,” the researchers wrote. “In addition, [canagliflozin 100 mg] and [canagliflozin 300 mg] monotherapy provided comparable HbA1c reductions and greater weight loss compared with [metformin] monotherapy.” – by Amber Cox

Disclosure: Rosenstock reports serving on scientific advisory boards and receiving honoraria or consulting fees from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lilly, Janssen, Lexicon, Merck and Pfizer. Please see the full study for a list of all other authors’ relevant financial disclosures.