INVOKANA®
PRODUCT INFORMATION
Page 1 of 28INVOKANA (140219) API
name of the MEDICINE
Canagliflozin
The chemical name is (1S)-1,5-anhydro-1[3[[5(4fluorophenyl)-2-thienyl]methyl]-4-methylphenyl]-D-glucitol present in the tablets as the hemihydrate.
Molecular Formula: C24H25FO5S.½ H2O
CAS: 928672-86-0(hemihydrate) and 842133-18-0(anhydrous)
MW:453.53
DESCRIPTION
Canagliflozin hemihydrate drug substance is a white to off white powder, soluble in many organic solvents (ethanol, methanol, tetrahydrofuran,acetone) but insoluble in aqueous media.The log P of the drug substance is 3.44 at 20oC and pH=7. There is no pKa in the physiological pH range.
INVOKANA is available as film-coated tablets containing 100 and 300 mg of canagliflozin present as 102 mg and 306 mg of canagliflozin hemihydrate in each tablet strength, respectively. Both strengths contain the inactive ingredients microcrystalline cellulose, lactose anhydrous, croscarmellose sodium, hydroxypropyl cellulose, magnesium stearate, polyvinyl alcohol, titanium dioxide, macrogol 3350 and talc-purified. In addition, the 100 mg strength contains iron oxide yellow.
Pharmacology
Mechanism of Action
INVOKANA is an inhibitor of sodium-glucose cotransporter2 (SGLT2). SGLT2, expressed in the proximal renal tubules, is responsible for the majority of the reabsorption of filtered glucose from the tubular lumen. Patients with diabetes have been shown to have elevated renal glucose reabsorption which may contribute to persistent elevated blood glucose concentrations. Canagliflozin is an orallyactive inhibitor of SGLT2. By inhibiting SGLT2, canagliflozin reduces reabsorption of filtered glucose and lowers the renal threshold for glucose (RTG), and thereby increases urinary glucose excretion (UGE), lowering elevated plasma glucose concentrations by an insulinindependent mechanism in patients with type2 diabetes. Urinary glucose excretion induced by canagliflozin leads to an osmotic diuresis, which can be associated with caloric loss and reduction in weight(see PHARMACOLOGY - Clinical Studies).
In Phase3 studies in which a mixed meal tolerance test was performed, canagliflozin 300mg provided a greater reduction in postprandial glucose excursion than observed at 100mg. Clinical studies have shown no glucose malabsorption with canagliflozin.
Pharmacodynamics
Following single and multiple oral doses of canagliflozin in patients with type2 diabetes, dosedependent decreases in the renal threshold for glucose (RTG) and increases in UGE were observed. From a starting value of RTG of approximately 13mmol/L, maximal suppression of 24hour mean RTG was seen with the 300mg daily dose to approximately 4 to 5mmol/L in patients with type2 diabetesin Phase1 studies (see Figure 1), suggesting a low risk for treatmentinduced hypoglycaemia. In patients with type2 diabetes given 100 to 300mg once daily over a 16day dosing period, reductions in RTG and increases in UGE were sustained over the dosing period. In this study, plasma glucose declined in a dosedependent fashion within the first day of dosing with subsequent sustained fasting and postprandial glucose lowering.
Figure1:Predicted (PK/PD Modelled) 24Hour Profile for RTG in Subjects with Type2 Diabetes Treated with Canagliflozin 100mg and 300mg
In singledose studies in patients with type2 diabetes, treatment with 300mg before a mixed meal delayed intestinal glucose absorption and reduced postprandial glucose through a nonrenal mechanism.
Cardiac Electrophysiology
In a randomised, doubleblind, placebocontrolled, activecomparator, 4way crossover study, 60healthy subjects were administered a single oral dose of canagliflozin 300mg, canagliflozin 1,200mg (4times the maximum recommended dose), moxifloxacin, and placebo. No meaningful changes in QTc interval were observed with either the recommended dose of 300mg or the 1,200mg dose. At the 1,200mg dose, peak canagliflozin plasma concentrations were approximately 1.4times the steadystate peak concentrations following a 300mg oncedaily dose.
Blood pressure
In an analysis of four 26week, placebocontrolled studies (N=2,313), mean reductions in systolic blood pressure relative to placebo were observed with canagliflozin 100mg (3.9mmHg), canagliflozin 300mg (5.3mmHg), and placebo (0.1mmHg). In this same population, there was a smaller effect on diastolic blood pressure with mean changes of 2.1mmHg with canagliflozin 100mg, 2.5mmHg with canagliflozin 300mg, and 0.3mmHg with placebo. There was no discernible change in heart rate.
Lipid effects
In an integrated analysis of four placebocontrolled studies of 26weeks, patients with type2 diabetes treated with both doses of canagliflozin had increased serum concentrations of total cholesterol, LDLC, and HDLC (highdensity lipoprotein cholesterol) compared to small changes in placebo, while serum concentrations of triglycerides decreased compared to placebo. At week26, the LDLC/HDLC ratio minimally changed compared to baseline in all three treatment groups. Similar to changes observed in nonHDLC, concentrations of ApoB and LD particle number (measured in two studies) increased to a smaller extent than LDLC changes in the monotherapy and 26week metformin addon therapy study (see ADVERSE EFFECTS).
Pharmacokinetics
The pharmacokinetics of canagliflozin are essentially similar in healthy subjects and patients with type2 diabetes. After singledose oral administration of 100mg and 300mg in healthy subjects, canagliflozin was rapidly absorbed, with peak plasma concentrations (median Tmax) occurring 1 to 2hours postdose. Plasma Cmax and AUC of canagliflozin increased in a doseproportional manner from 50mg to 300mg. The apparent terminal halflife (t1/2) was 10.6hours and 13.1hours for the 100mg and 300mg doses, respectively. Steadystate was reached after 4 to 5days of oncedaily dosing with canagliflozin 100mg to 300mg. Canagliflozin does not exhibit timedependent pharmacokinetics, and accumulated in plasma up to 36% following multiple doses of 100mg and 300mg.
Absorption:
The mean absolute oral bioavailability of canagliflozin is approximately65%. Coadministration of a highfat meal with canagliflozin had no effect on the pharmacokinetics of canagliflozin; therefore, canagliflozin may be taken with or without food. However, based on the potential to reduce postprandial plasma glucose excursions due to delayed intestinal glucose absorption, it is recommended that canagliflozin be taken before the first meal of the day (see DOSAGE AND ADMINISTRATION; PHARMACOLOGY – Pharmacodynamics).
Distribution:
The mean steadystate volume of distribution of canagliflozin following a single intravenous infusion in healthy subjects was 119L, suggesting extensive tissue distribution. Canagliflozin is extensively bound to proteins in plasma (98%), mainly to albumin. Protein binding is independent of canagliflozin plasma concentrations. Plasma protein binding is not meaningfully altered in patients with renal or hepatic impairment.
Metabolism:
Oglucuronidation is the major metabolic elimination pathway for canagliflozin, which is mainly glucuronidated by UGT1A9 and UGT2B4 to two inactive Oglucuronide metabolites. CYP3A4mediated (oxidative) metabolism of canagliflozin is minimal (approximately 7%) in humans.
Excretion:
Following administration of a single oral [14C]canagliflozin dose to healthy subjects, 41.5%, 7.0%, and 3.2% of the administered radioactive dose was recovered in faeces as canagliflozin, a hydroxylated metabolite, and an Oglucuronide metabolite, respectively. Enterohepatic circulation of canagliflozin was negligible.
Approximately 33% of the administered radioactive dose was excreted in urine, mainly as Oglucuronide metabolites (30.5%). Less than 1% of the dose was excreted as unchanged canagliflozin in urine. Renal clearance for the 100mg and 300mg doses ranged from 1.30 to 1.55mL/min.
Canagliflozin is a lowclearance medicinal product, with a mean systemic clearance of approximately 192mL/min in healthy subjects following intravenous administration.
Special Populations:
Renal Impairment:
A singledose, openlabel study evaluated the pharmacokinetics of canagliflozin 200mg in subjects with varying degrees of renal impairment (classified using the MDRDeGFR formula) compared to healthy subjects. The study included 3subjects with normal renal function (CKD Stage 1; eGFR≥90mL/min/1.73m2), 10subjects with mild renal impairment (CKD stage 2; eGFR60 to <90mL/min/1.73m2), 9subjects with moderate renal impairment (CKD stage 3; eGFR30 to <60mL/min/1.73m2), and 10subjects with severe renal impairment (CKD stage 4; eGFR15 to <30mL/min/1.73m2) as well as 8subjects with endstage renal disease on haemodialysis (CKD stage 5).
Renal impairment did not affect the Cmax of canagliflozin. Compared to healthy subjects, plasma AUC of canagliflozin was increased by approximately 15%,29%, and 53% in subjects with mild, moderate, and severe renal impairment, respectively, but was similar for end stage renal disease subjects and healthy subjects. Increases in canagliflozin AUC of this magnitude are not considered clinically relevant (see DOSAGE AND ADMINISTRATION; PRECAUTIONS; ADVERSE EFFECTS).
Canagliflozin was negligibly removed by haemodialysis.
Hepatic Impairment:
Relative to subjects with normal hepatic function, the Cmax and AUC∞ of canagliflozin increased by 7% and 10%, respectively, in subjects with ChildPugh classA (mild hepatic impairment) and decreased by 4% and increased by 11%, respectively, in subjects with ChildPugh classB (moderate hepatic impairment) following administration of a single 300mg dose of canagliflozin.
These differences are not considered to be clinically meaningful. No dose adjustment is necessary in patients with mild or moderate hepatic impairment. There is no clinical experience in patients with ChildPugh classC (severe) hepatic impairment and, therefore, INVOKANA is not recommended for use in this patient population.
Elderly:
Age had no clinically meaningful effect on the pharmacokinetics of canagliflozin based on a population pharmacokinetic analysis (see DOSAGE AND ADMINISTRATION; PRECAUTIONS; ADVERSE EFFECTS).
Paediatric:
Studies characterising the pharmacokinetics of canagliflozin in paediatric patients have not been performed.
Characteristics of other special populations:
No dose adjustment is necessary based on gender, race/ethnicity, or body mass index. These characteristics had no clinically meaningful effect on the pharmacokinetics of canagliflozin based on a population pharmacokinetic analysis.
CLINICAL TRIALS
INVOKANA has been studied as monotherapy (DIA3005), in combination with metformin (DIA3006 and DIA3009), sulfonylurea (DIA3008), metformin and sulfonylurea (DIA3002 and DIA3015), metformin and a
thiazolidinedione (i.e. pioglitazone; DIA3012), and in combination with insulin (with or without other antihyperglycemic agents; DIA3008).
INVOKANA has also been studied in patients 55 to 80 years of age (DIA3010) and in patients with moderate renal impairment (DIA3004). In these studies, INVOKANAwas added to patients' existing diabetic therapy (eg, metformin, sulfonylurea, pioglitazone, alpha-glucosidase inhibitor, DPP4 inhibitors, or GLP1 agonists).
A total of 10,285patients with type2 diabetes who received medicinal product participated in nine doubleblind, controlled clinical efficacy and safety studies conducted to evaluate the effects of INVOKANA on glycaemic control. Approximately 58% of patients were male. Patients had an overall mean age of 59.5years (range 21 to 96years), with 3,082patients 65years of age and older and 510patients ≥75years of age. One study was conducted in patients with renal impairment with an eGFR30 to <50mL/min/1.73m2 (N=269) and three other studies included patients with renal impairmentwith an eGFR30 to <60mL/min/1.73m2 (N=816).
INVOKANA produced clinically and statistically significant improvements relative to placebo in glycaemic control, including HbA1c, percentage of patients achieving HbA1c7%, change from baseline fasting plasma glucose (FPG) and 2hour postprandial glucose (PPG), and clinically relevant improvement in percent change in body weight. The reductions in HbA1c were similar across different subgroups including age, gender, race, body mass index (BMI), and baseline betacell function. Greater reductions in HbA1c relative to placebo were observed in patients with higher baseline HbA1c or higher eGFR values.
For patients treated with canagliflozin there are no clinical data regarding substitution of canagliflozin with another SGLT2 inhibitor.
Efficacy of canagliflozin is dependent on renal function. Reductions in mean HbA1c relative to placebo ranged from 0.62 to 0.91 for the 100 mg canagliflozin dose and 0.76 to 1.16 for the 300mg dose. The effect was reduced in older subjects (mean reduction of 0.57 and 0.70 for the 100mg and 300mg doses respectively), subjects taking insulin (mean reduction of 0.65 and 0.73 for the 100 mg and 300 mg doses respectively) and in subjects with moderate renal impairment (mean reductions of 0.3 and 0.4 for the 100 mg and 300 mg doses respectively).
Table1: HbA1c (%) Change from Baseline to Primary Assessment Timepoint - LOCF: Study-by-Study Comparison (ISE Phase 3 Studies: Modified Intent-to-Treat Analysis Set)Placebo / CANA 100 mg / CANA 300 mg / Sitagliptin / Glimepiride
Monotherapy
DIA3005
Baseline, mean (SD) / 7.97(0.955) / 8.06(0.959) / 8.01(0.988)
Change from baseline, LS mean (SE) / 0.14(0.065) / -0.77(0.065) / -1.03(0.064)
Diff of LS mean (SE) (minus placebo) / -0.91(0.091) / -1.16(0.091)
95% CIa / (-1.088;-0.729) / (-1.342;-0.985)
Dual therapy
DIA3006
Add-on to metformin
Baseline, mean (SD) / 7.96(0.896) / 7.94(0.879) / 7.95(0.931) / 7.92(0.875)
Change from baseline, LS mean (SE) / -0.17(0.060) / -0.79(0.044) / -0.94(0.044) / -0.82(0.044)
Diff of LS mean (SE) (minus placebo) / -0.62(0.071) / -0.77(0.071)
95% CIa / (-0.758;-0.481) / (-0.914;-0.636)
DIA3009
Add-on to metformin
Baseline, mean (SD) / 7.78(0.787) / 7.79(0.779) / 7.83(0.795)
Change from baseline, LS mean (SE) / -0.82(0.039) / -0.93(0.039) / -0.81(0.039)
Diff of LS mean (SE) (minus glimepiride) / -0.01(0.050) / -0.12(0.050)
95% CIa / (-0.109;0.085) / (-0.217;-0.023)
DIA3008 substudy
Add-on to SU
Baseline, mean (SD) / 8.49(1.130) / 8.29(0.831) / 8.28(1.005)
Change from baseline, LS mean (SE) / 0.04(0.146) / -0.70(0.145) / -0.79(0.147)
Diff of LS mean (SE) (minus placebo) / -0.74(0.206) / -0.83(0.207)
95% CIa / (-1.145;-0.329) / (-1.237;-0.415)
Triple therapy
DIA3002
Add-on to metformin and SU
Baseline, mean (SD) / 8.12(0.896) / 8.13(0.926) / 8.13(0.942)
Change from baseline, LS mean (SE) / -0.13(0.075) / -0.85(0.075) / -1.06(0.076)
Diff of LS mean (SE) (minus placebo) / -0.71(0.097) / -0.92(0.097)
95% CIa / (-0.904;-0.524) / (-1.114;-0.732)
DIA3012
Add-on to metformin and pioglitazone
Baseline, mean (SD) / 8.00(1.010) / 7.99(0.940) / 7.84(0.911)
Change from baseline, LS mean (SE) / -0.26(0.069) / -0.89(0.069) / -1.03(0.070)
Diff of LS mean (SE) (minus placebo) / -0.62(0.095) / -0.76(0.096)
95% CIa / (-0.811;-0.437) / (-0.951;-0.575)
DIA3015
Add-on to metformin and SU
Baseline, mean (SD) / 8.12 (0.910) / 8.13 (0.916)
Change from baseline, LS mean (SE) / -1.03 (0.048) / -0.66 (0.049)
Diff of LS mean (SE) (minus sitagliptin) / -0.37 (0.064)
95% CIa / (-0.500;-0.250)
Add-on to insulin
With or without other antihyperglycaemic agent
DIA3008 substudy
Baseline, mean (SD) / 8.20(0.837) / 8.33(0.905) / 8.27(0.894)
Change from baseline, LS mean (SE) / 0.01(0.032) / -0.63(0.031) / -0.72(0.030)
Diff of LS mean (SE) (minus placebo) / -0.65(0.044) / -0.73(0.043)
95% CIa / (-0.731;-0.559) / (-0.815;-0.645)
Special populations
DIA3004
Moderate renal impairment
Baseline, mean (SD) / 8.02(0.917) / 7.89(0.898) / 7.97(0.805)
Change from baseline, LS mean (SE) / -0.03(0.090) / -0.33(0.090) / -0.44(0.089)
Diff of LS mean (SE) (minus placebo) / -0.30(0.117) / -0.40(0.117)
95% CIa / (-0.529;-0.066) / (-0.635;-0.174)
DIA3010
Older adults (≥ 55 years)
Baseline, mean (SD) / 7.76(0.785) / 7.77(0.773) / 7.69(0.779)
Change from baseline, LS mean (SE) / -0.03(0.063) / -0.60(0.063) / -0.73(0.064)
Diff of LS mean (SE) (minus placebo) / -0.57(0.069) / -0.70(0.070)
95% CIa / (-0.708;-0.436) / (-0.841;-0.566)
a Pairwise comparison: CIs are based on the ANCOVA model with treatment, study specific stratification factors and baseline HbA1c.
Key: CANA=canagliflozin, CI = confidence interval, ISE = Integrated Summary of Efficacy, LOCF = last observation carried forward, LS = least squares, N = number, SD= standard deviation, SE = standard error, SU=sulfonylurea.
Note: Predefined timepoint of primary endpoint: Week 18 LOCF (DIA3008 SU and Insulin substudies), Week 26 LOCF (DIA3002, DIA3004, DIA3005 [excluding High Glycemic substudy], DIA3006, DIA3010, DIA3012) and Week 52 LOCF (DIA3009, DIA3015).
Note: Data for DIA3008 SU substudy presented for Population 1 (subjects on protocol-specified doses of SU monotherapy regardless of stratification), while data for DIA3008 Insulin substudy presented for Population 2 (subjects receiving insulin dose ≥30 IU/day).
Monotherapy study(INVOKANA as monotherapy in patients ineligible for metformin)
Study DIA3005
INVOKANA as monotherapy produced statistically significant (p<0.001) and sustained reductions in HbA1c relative to placebo over 26weeks. In addition, statistically significant improvements relative to placebo were observed for the percent change in body weight. Patients with more severe hyperglycaemia (HbA1c10 and ≤12%) participated in a separate activetreatment substudy; canagliflozinproduced significant reductions in HbA1c and body weight.
Table2: Results from 26week placebocontrolled clinical study with INVOKANA as monotherapy1Efficacy parameter / INVOKANA 100mg
(N=195) / INVOKANA 300mg
(N=197) / Placebo
(N=192)
HbA1c (%)
Baseline (mean) / 8.06 / 8.01 / 7.97
Change from baseline (adjusted mean) / 0.772 / 1.032 / 0.14
Difference from placebo (adjusted mean) (95% CI) / -0.912
(-1.09; -0.73) / -1.162
(-1.34; -0.99) / N/A
Patients (%) achieving HbA1c7% / 44.52 / 62.42 / 20.6
Body weight
Baseline (mean) in kg / 85.9 / 86.9 / 87.5
% change from baseline (adjusted mean) / 2.82 / 3.92 / 0.6
Difference from placebo (adjusted mean) (95% CI) / -2.22
(-2.9; -1.6) / -3.32
(-4.0; -2.6) / N/A
Systolic Blood Pressure (mmHg)1
Baseline (mean) / 126.7 / 128.5 / 127.7
Change from baseline (adjusted mean) / -3.3 / -5.0 / 0.4
Difference from placebo (adjusted mean) (95% CI) / -3.72
(-5.9; -1.6) / -5.42
(-7.6; -3.3) / N/A
Activetreatment substudy of patients with high baseline HbA1c concentrations (>10 to ≤12%)
Efficacy parameter / INVOKANA 100mg
(N=47) / INVOKANA 300mg
(N=44)
HbA1c (%)
Baseline (mean) / 10.59 / 10.62
Change from baseline (adjusted mean) / 2.13 / 2.56
Patients (%) achieving HbA1c7% / 17.4 / 11.6
Body weight
Baseline (mean) in kg / 83.2 / 81.6
% Change from baseline (adjusted mean) / 3.0 / 3.8
Systolic Blood Pressure (mmHg)
Baseline (mean) / 125.0 / 126.6
Change from baseline (adjusted mean) / -4.5 / -5.0
1Intenttotreat population using last observation in study prior to metformin rescue.
2p<0.001 compared to placebo.
N/A = Not applicable.
Dual therapy studies (INVOKANA with metformin or sulphonylurea)
StudyDIA3006
INVOKANA as dual therapy with metformin produced statistically significant (p<0.001) and sustained reductions in HbA1c relative to placebo over 26weeks. In addition, significant and sustained improvements relative to placebo were observed for the percent change in body weight.
Table3: Results from 26week placebocontrolled clinical study of INVOKANA as dual therapy with metformin1Efficacy parameter / INVOKANA + metformin / Placebo + metformin
(N=183)
100mg
(N=368) / 300mg
(N=367)
HbA1c (%)
Baseline (mean) / 7.94 / 7.95 / 7.96
Change from baseline (adjusted mean) / 0.79 / 0.94 / 0.17
Difference from placebo (adjusted mean) (95% CI) / -0.622
(-0.76; -0.48) / -0.772
(-0.91; -0.64) / N/A
Patients (%) achieving HbA1c7% / 45.52 / 57.82 / 29.8
Body weight
Baseline (mean) in kg / 88.7 / 85.4 / 86.7
% change from baseline (adjusted mean) / 3.72 / 4.22 / 1.2
Difference from placebo (adjusted mean) (95% CI) / -2.52
(-3.1; -1.9) / -2.92
(-3.5; -2.3) / N/A
Systolic Blood Pressure (mmHg)1
Baseline (mean) / 128.0 / 128.7 / 128.0
Change from baseline (adjusted mean) / -3.8 / -5.1 / 1.5
Difference from placebo (adjusted mean) (95% CI) / -5.42
(-7.3; -3.4) / -6.62
(-8.5; -4.6) / N/A
1Intenttotreat population using last observation in study prior to glycaemic rescue therapy.
2p<0.001 compared to placebo.
N/A = Not applicable
Study DIA3009
INVOKANA as dual therapy with metformin produced similar reductions in HbA1c with INVOKANA100mg from baseline compared to glimepiride and superior (p<0.05) reductions in HbA1c with INVOKANA300mg compared to glimepiride. These reductions were sustained over the course of the 52week period. In the glimepiride arm of the study, glimepiride was titrated to optimise glycaemic control throughout the 52week study. In addition, significant improvements relative to glimepiride were observed for the percent change in body weight.
A subset of patients (N=208) who underwent DXA and abdominal CT scans for evaluation of body composition demonstrated that approximately twothirds of the weight loss with canagliflozin was due to loss of fat mass with similar amounts of visceral and abdominal subcutaneous fat being lost.
Table4: Results from 52week clinical study comparing INVOKANA to glimepiride as dual therapy with metformin1Efficacy parameter / INVOKANA + metformin / Glimepiride (titrated) + metformin
(N=482)
100mg
(N=483) / 300mg
(N=485)
HbA1c (%)
Baseline (mean) / 7.78 / 7.79 / 7.83
Change from baseline (adjusted mean) / 0.822 / 0.932 / 0.81
Difference from glimepiride (adjusted mean) (95% CI) / 0.012
(−0.11; 0.09) / 0.122
(−0.22; −0.02) / N/A
Patients (%) achieving HbA1c7% / 53.6 / 60.1 / 55.8
Body weight
Baseline (mean) in kg / 86.8 / 86.6 / 86.6
% change from baseline (adjusted mean) / 4.2 / 4.7 / 1.0
Difference from glimepiride (adjusted mean) (95% CI) / 5.24
(−5.7; −4.7) / 5.74
(−6.2; −5.1) / N/A
Systolic Blood Pressure (mmHg5)
Baseline (mean) / 130.0 / 130.0 / 129.5
Change from baseline (adjusted mean) / 3.3 / 4.6 / 0.2
Difference from glimepiride (adjusted mean) (95% CI) / 3.5
(−4.9; −2.1) / 4.8
(−6.2; −3.4) / N/A
1Intenttotreat population using last observation in study prior to glycaemic rescue therapy.
295% confidence intervals 100mg (−0.11;0.09), 300mg (−0.22;−0.02). Met prespecified criteria for noninferiority to glimepiride (with the upper bound of the 95% CI around the betweengroup difference less than the prespecified noninferiority margin of <0.3%). In a prespecified assessment, the upper bound of the 95% CI for INVOKANA 300mg, but not for INVOKANA 100mg was <0, indicating greater reduction in A1C for INVOKANA 300 mg relative to glimepiride.
3p<0.001.
N/A = Not applicable
4 Includes only patients who had both baseline and post-baseline values
Figure 2.Mean Changes from Baseline for HbA1C (%)Over 52Weeks in a Study Comparing INVOKANA to Glimepiride in Combination with Metformin
Figure 3.Mean Changes from Baseline for Body Weight Over 52Weeks in a Study Comparing INVOKANA to Glimepiride in Combination with Metformin
Study DIA3008 – Sulphonylurea Substudy
INVOKANA as dual therapy with sulphonylurea produced statistically significant (p<0.001) improvements in HbA1c over 18weeks. In addition, INVOKANA as dual therapy with sulphonylurea resulted in a reduction in the percent change in body weight relative to placebo.
Table5: Results from 18week placebocontrolled clinical study of INVOKANA as dual therapy with sulphonylurea1Efficacy parameter / INVOKANA + sulphonylurea / Placebo + sulphonylurea
(N=45)
100mg
(N=42) / 300mg
(N=40)
HbA1c (%)
Baseline (mean) / 8.29 / 8.28 / 8.49
Change from baseline (adjusted mean) / 0.702 / 0.792 / 0.04
Difference from placebo (adjusted mean) (95% CI) / -0.742
(-1.15; -0.33) / -0.832
(-1.24; -0.41) / N/A
Patients (%) achieving HbA1c7% / 25.03 / 33.33 / 5.0
Body weight
Baseline (mean) in kg / 85.1 / 80.4 / 85.5
% change from baseline (adjusted mean) / 0.6 / 2.0 / 0.2
Difference from placebo (adjusted mean) (95% CI) / -0.4
(-1.8; 1.0) / -1.8
(-3.2; -0.4) / N/A
Systolic Blood Pressure (mmHg)1
Baseline (mean) / 138 / 133.5 / 137.3
Change from baseline (adjusted mean) / 3.5 / 5.1 / 3.4
Difference from placebo (adjusted mean) (95% CI) / 0.1
(6.5; 6.2) / 1.8
(8.2; 4.7) / N/A
1Intenttotreat population using last observation in study prior to glycaemic rescue therapy.
2p<0.001 compared to placebo
3 p<0.01
N/A = Not applicable
Triple therapy studies (INVOKANA with metformin and sulphonylurea or metformin and pioglitazone)
Study DIA3002
INVOKANA as triple therapy with metformin and sulphonylurea produced statistically significant (p<0.001) and sustained reductions in HbA1c relative to placebo over 26weeks. In addition, statistically significant improvements in the percent change in body weight were observed.