Another SGLT2 That You Can Feel Safe Prescribing

Charles P. Vega, MD


July 27, 2018

Hello. I'm Dr Charles Vega, and I am a clinical professor of family medicine at the University of California at Irvine. Welcome to Medscape Morning Report, our 1-minute news story for primary care.

A new study concludes that canagliflozin (Invokana) is not associated with an increased risk for below-knee amputations. A previous large trial[1] had raised this concern, although predominantly in patients with risk factors, including previous amputations, peripheral vascular disease, severe neuropathy, or high A1c.

But this new observational study, based on data from more than 700,000 patients, found no increase in risk with use of this agent compared with other sodium-glucose co-transporter-2 (SGLT2) inhibitors or glucose-lowering medications. As expected, canagliflozin was associated with a lower rate of hospitalization due to heart failure compared with other medications for diabetes.

The new data are important because drugs in the SGLT2 class are associated with reductions in cardiovascular events—a major concern for patients with diabetes.

While reassuring, the drug still carries a US Food and Drug Administration–mandated black box warning for amputations, so physicians are obligated to discuss the amputation risk with all patients, regardless of risk status. However, these new data can provide important context for that discussion.


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