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. 2022 Jan;39(1):674-691.
doi: 10.1007/s12325-021-01984-4. Epub 2021 Dec 2.

Real-World Safety and Effectiveness of Canagliflozin Treatment for Type 2 Diabetes Mellitus in Japan: SAPPHIRE, a Long-Term, Large-Scale Post-Marketing Surveillance

Nobuya Inagaki  1 , Masaomi Nangaku  2 , Yasushi Sakata  3 , Kazuyo Sasaki  4 , Kazumi Mori-Anai  5 , Tomohisa Iwasaki  5 , Koume Hamada  6
Affiliations

Real-World Safety and Effectiveness of Canagliflozin Treatment for Type 2 Diabetes Mellitus in Japan: SAPPHIRE, a Long-Term, Large-Scale Post-Marketing Surveillance

Nobuya Inagaki et al. Adv Ther. 2022 Jan.

Abstract

Introduction: This long-term post-marketing surveillance (SAPPHIRE) collected information on the safety and effectiveness of canagliflozin (approved dose 100 mg) prescribed to patients with type 2 diabetes mellitus (T2DM) in real-world practice in Japan.

Methods: Patients with T2DM who were prescribed canagliflozin between December 2014 and September 2016 were registered and observed for up to 3 years. Safety was evaluated in terms of adverse drug reactions (ADRs). Effectiveness was assessed in terms of glycaemic control. Data were also analysed across age subgroups (< 65, ≥ 65 to < 75, and ≥ 75 years old) and the estimated glomerular filtration rate (eGFR) categories for chronic kidney disease (G1-G5 based on eGFR) at baseline.

Results: A total of 12,227 patients were included in the safety analyses and 11,675 in effectiveness analyses. Overall, 7104 patients were treated with canagliflozin for ≥ 3 years. The mean age, haemoglobin A1c (HbA1c), and eGFR at baseline were 58.4 ± 12.5 years, 8.01 ± 1.49%, and 80.04 ± 21.85 mL/min/1.73 m2, respectively. There were 1836 ADRs in 1312 patients (10.73%) and 268 serious ADRs in 225 patients (1.84%). The most common ADRs were those related to volume depletion (1.39%), genital infection (1.34%), polyuria/pollakiuria (1.23%), and urinary tract infection (1.19%). The frequencies of ADRs tended to increase with age and stage of chronic kidney disease. The reductions in mean HbA1c after starting canagliflozin were maintained for up to 3 years with a mean change of - 0.68% (n = 6345 at 3 years). Maintained reductions in mean HbA1c were observed in each age subgroup and in patients with G1-G3b renal function.

Conclusion: This surveillance in real-world clinical practice showed that canagliflozin provides sustained glucose-lowering effects in patients with T2DM, including elderly patients and patients with moderate renal impairment, without new safety concerns beyond those already described in the Japanese package insert.

Trial registration: JapicCTI-153048.

Keywords: Canagliflozin; Japan; Post-marketing surveillance; Real-world; Safety; Sodium–glucose cotransporter 2 inhibitor; Type 2 diabetes mellitus.

Plain language summary

Canagliflozin is a sodium–glucose cotransporter 2 (SGLT2) inhibitor that lowers blood glucose levels by increasing urinary glucose excretion. It was approved for the management of blood glucose levels in patients with type 2 diabetes mellitus following clinical trials. However, clinical trials may not fully represent the safety or effectiveness of a drug in real-world clinical practice. Therefore, a 3-year post-marketing surveillance was performed in Japan to obtain safety and effectiveness data for a large group of 12,227 patients with type 2 diabetes mellitus and various demographic/clinical characteristics. Safety and effectiveness data were collected for up to 3 years while patients were treated with canagliflozin. Adverse drug reactions occurred in 10.73% of patients. The most common types of adverse drug reactions were those related to volume depletion (body fluid decreased), followed by genital infection, polyuria/pollakiuria (increased urination), and urinary tract infection. Adverse drug reactions tended to be more common in elderly patients and in patients with renal impairment. As expected, canagliflozin was associated with improvements in haemoglobin A1c, a marker of blood glucose control, in patients with type 2 diabetes, including in elderly patients and patients with moderate renal impairment. In this surveillance in real-world clinical practice, long-term treatment with canagliflozin raised no new safety concerns beyond the information already included in the Japanese package insert. Canagliflozin provides sustained glucose-lowering effects.

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Figures

Fig. 1
Fig. 1
Patient disposition. *Multiple reasons may apply. CRF case report form
Fig. 2
Fig. 2
Adverse drug reactions/adverse events of special interest (n = 12,227)
Fig. 3
Fig. 3
Changes in eGFR over time in patients divided into subgroups by renal function at baseline. Values are mean ± standard deviation with p values from paired t tests. eGFR estimated glomerular filtration rate, LOCF last observation carried forward, mo month
Fig. 4
Fig. 4
Changes in HbA1c over time in the overall cohort (a) and in patients divided into subgroups by age (b) and eGFR (c) at baseline. In c, data are shown for G1–G4. Values are mean ± standard deviation with p values from paired t tests. eGFR estimated glomerular filtration rate, LOCF last observation carried forward, mo month
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References

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