SGLT-2 Inhibitors

A New Modality for Treating Type 2 Diabetes

David Joffe BSPharm, CDE, Clinical Assistant Professor of Pharmacotherapy and Translational Research Courtney Glanzrock, PharmD Candidate University of Florida College of Pharmacy

Two sodium glucose transporters, cause glucose reabsorption, have been identified: SGLT-1 and SGLT-2

SGLT-2 is found only in the proximal tubule of the kidney, accounts for 90% of the re-absorption of glucose

SGLT-1 is found in the gut and other tissues, account for approximately 10% of glucose reabsorption

SGLT-1 and SGLT-2

Invokana (Canagliflozin) 1st SGLT-2 inhibitor, approved March 2013

Once daily dosing before 1st meal of day, 100mg or 300mg tablets

MOA: Inhibition of SGLT2 reduces reabsorption of glucose in the kidney, resulting in increased urinary glucose excretion, with a consequent lowering of plasma glucose levels as well as weight loss.

Blocks approximately 50-80 grams of glucose per day from being reabsorbed

SGLT-2 Inhibitor - Canagliflozin

SGLT2-I

Positive effects: Reduction in body weight and systolic blood pressure

Side effects: Most common: Vaginal yeast infection, urinary tract infection and increased urination. Hypoglycemia (<5%), dehydration, dizziness or fainting, hyperkalemia

Contraindications: Clinicians should not use canagliflozin to treat patients with type 1 diabetes, patients with type 2 diabetes who have increased ketones in their blood or urine, severe renal impairment, end-stage renal disease or patients receiving dialysis

SGLT-2 Inhibitor-Canagliflozin

SGLT-2 InhibitorFirst In Class

Canagliflozin Side Effects

http://www.invokanahcp.com/safety-information/safety-and-tolerability-profile?utm_source=google&utm_medium=cpc&utm_campaign=Invokana+HCP&utm_term=canagliflozin%20side%20effects&utm_content=Side+Effects+-+Exact|mkwid|suZUJen2m|pcrid|24016786155

Drug Interactions:1.UGT Inducers (Rifampin, Phenytoin,

Phenobarbitol, Ritonavir)- Decreased canagliflozin, consider increasing dose of canagliflozin

2.Digoxin- Increased digoxin concentration, monitor levels

Pregnancy Category C Do Not Use: GFR <30mL/min, end stage renal

disease, or patients on dialysis

Canagliflozin

Pre-Marketing Study Results: Average decrease in A1C levels 1%Weight Loss average 5-10 poundsDecrease in systolic blood pressure

approximately 4%Increase HDL approximately 7.6% Increase LDL approximately 11.7%Low risk of hypoglycemia

SGLT-2 Inhibitor-Canagliflozin

Pipeline:1.Empagliglozin (Eli Lilly/Behringer)2.Dapagliflozin (AstraZeneca)3.Remogliflozin Etabonate (GlaxoSmithKline)4.Sergliflozin Etabonate (GlaxoSmithKline)5.Tofoglitazone (Roche & Chugal)

SGLT-2 Inhibitors

Medication Average A1C lowering

Hypoglycemic Agent

Weight Gain/Loss

Metformin 1.5% No Loss

Sulfonylureas 1.5% Yes Gain

Glinides 1-1.5% No Gain

SGLT-2 Inhibitors

1% No Loss

TZDs 0.5-1.4% No Gain

α-Glucosidase Inhibitor

0.5-0.8% No Neutral

DPP-4 Inhibitors

0.5-1% No Neutral

Comparing Agents

Berkrot, Bill. "Johnson & Johnson Diabetes Drug Tops Older Therapies in Studies." Reuters. Thomson Reuters, 09 June 2012. Web. 02 Apr. 2013.

"Canagliflozin Provided Substantial and Sustained Glycemic Improvements as Monotherapy and in Add-On Combinations in Adults with Type 2 Diabetes in Five Phase 3 Studies." Johnson & Johnson. Jansen Research & Development, 09 June 2012. Web. 02 Apr. 2013.

Clarke, Toni. "FDA Approves Johnson & Johnson Diabetes Drug, Canagliflozin." Reuters. Thomson Reuters, 29 Mar. 2013. Web. 01 Apr. 2013.

"Diabetes Treatment, Part 2: Oral Agents for Glycemic Management." Clinical Diabetes. N.p., Oct. 2007. Web. 12 Apr. 2013.

FDA Approves Invokana to Treat Type 2 Diabetes. N.p., n.d. Web. 01 Apr. 2013

"Invokana." INVOKANA™ (Canagliflozin) Treatment for Type 2 Diabetes. N.p., n.d. Web. 12 Apr. 2013

Nainggolan, Lisa. "FDA Approves Canagliflozin, a First-in-Class Diabetes Drug." Medscape Log In. N.p., 29 Mar. 2013. Web. 01 Apr. 2013.

References