consider this independent network meta-analysis when choosing an SGLT2i1

Network meta-analysis study design:

Study published in the August 2016 issue of Diabetes, Obesity and Metabolism: A network meta-analysis of 38 randomized, placebo-controlled trials (N=23,997) to indirectly assess comparative efficacy and safety of SGLT2 inhibitors (INVOKANA® 100 mg and INVOKANA® 300 mg, Jardiance® [empagliflozin] 10 mg and Jardiance® 25 mg, and Farxiga® [dapagliflozin] 5 mg and Farxiga® 10 mg) based on data published up to November 3, 2015. All randomized controlled trials lasted ≥24 weeks and reported data on ≥1 cardiometabolic or safety outcomes. Cardiometabolic outcomes consisted of A1C, fasting plasma glucose, body weight (primary outcomes), systolic blood pressure, diastolic blood pressure, total cholesterol, LDL and HDL cholesterol, and triglycerides. Safety outcomes included all hypoglycemic events, urinary tract infection, genital infection, diabetic ketoacidosis, and bone fractures. Study quality was assessed using the Cochrane Risk of Bias Tool.1

Limitations of the network meta-analysis1:

  • Data were sourced only from journal articles or from ClinicalTrials.gov, which could risk publication bias
  • In some studies, outcomes may not be reported or it may not be possible to extract them in a suitable way; however, information was retrieved from all 38 trials for A1C and from 37 trials for body weight
  • Across randomized controlled trials, ethnicities of participants, follow-up durations, outcomes selection, definition, and ascertainment could differ; however, the authors deemed the network used in this analysis as consistent for A1C outcomes

There have been no head-to-head clinical trials comparing the efficacy or safety of SGLT2 inhibitors. No direct evaluation of comparative clinical profiles can be made.

Placebo-adjusted mean change in A1C (%) from an average mean baseline of 8.1%1

  • Indirect assessment of 38 randomized, placebo-controlled clinical trials of SGLT2 inhibitors of ≥24 weeks (N=23,997) based on data published up to November 3, 2015. Primary outcomes reported were A1C, fasting plasma glucose, and body weight1

Data reported are mean differences vs placebo (95% CI).

*Change in A1C was significantly greater with INVOKANA® 300 mg vs comparator.

SGLT2i=sodium-glucose co-transporter 2 inhibitor.

 

Placebo-adjusted mean change in body weight from baseline (lb)1

  • Indirect assessment of 37 randomized, placebo-controlled clinical trials of SGLT2 inhibitors of ≥24 weeks based on data published up to November 3, 2015. Primary outcomes reported were A1C, fasting plasma glucose, and body weight1

Data reported are mean differences vs placebo (95% CI).

*Change in body weight was significantly greater with INVOKANA® 300 mg vs comparator.

SGLT2i=sodium-glucose co-transporter 2 inhibitor.

INVOKANA® is not indicated for weight loss.

Placebo-adjusted mean change in systolic BP from baseline (mm Hg)1

  • Indirect assessment of 33 randomized, placebo-controlled clinical trials of SGLT2 inhibitors of ≥24 weeks (n=17,600) based on data published up to November 3, 2015. Primary outcomes reported were A1C, fasting plasma glucose, and body weight1

Data reported are mean differences vs placebo (95% CI).

*Change in systolic BP was significantly greater with INVOKANA® 300 mg vs comparator.

BP=blood pressure; SGLT2i=sodium-glucose co-transporter 2 inhibitor.

INVOKANA® is not indicated as an antihypertensive treatment.

Reference: 1. Zaccardi F, Webb DR, Htike ZZ, Youssef D, Khunti K, Davies MJ. Efficacy and safety of sodium-glucose co-transporter-2 inhibitors in type 2 diabetes mellitus: systematic review and network meta-analysis. Diabetes Obes Metab. 2016;18(8):783-794.