Canagliflozin

(Invokana®)

Invokana®

Drug updated on 4/24/2024

Dosage FormTablet (oral; 100 mg, 300 mg)
Drug ClassSodium-glucose co-transporter 2 inhibitors
Ongoing and
Completed Studies
ClinicalTrials.gov

Indication

  • Indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
  • Indicated to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus and established cardiovascular disease.
  • Indicated to reduce the risk of end-stage kidney disease, doubling of serum creatinine, cardiovascular death, and hospitalization for heart failure in adults with type 2 diabetes mellitus and diabetic nephropathy with albuminuria.

Latest News

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Summary
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  • Canagliflozin (Invokana) is indicated as an adjunct to diet and exercise for improving glycemic control in adults with type 2 diabetes mellitus. It also reduces the risk of major adverse cardiovascular events in these patients, especially those with established cardiovascular disease. Furthermore, it helps reduce the risk of end-stage kidney disease, doubling of serum creatinine levels, cardiovascular death, and hospitalization due to heart failure in adults suffering from type 2 diabetes mellitus along with diabetic nephropathy accompanied by albuminuria.
  • The information provided here is based on a review of 67 systematic reviews/meta-analyses related to Canagliflozin (Invokana).
  • Compared to older medications used for treating type 2 diabetes mellitus, Canagliflozin has shown better adherence rates among users. Its medication possession ratio ranges between 61.7% and 94.9%, indicating a good level of medication adherence.
  • In terms of safety considerations for elderly patients aged 65 years and older, Canagliflozin was well-tolerated but showed a six-fold increased risk for genital tract infections and a notable increase in amputations specifically amongst its users.
  • Canagliflozin significantly increases hematocrit and hemoglobin levels in patients suffering from Type 2 Diabetes Mellitus; particularly doses at 100mg and 200mg have shown the best effects on improving these parameters, respectively.
  • When compared against other SGLT2 inhibitors or antidiabetic drugs, including placebo groups regarding Diabetic Ketoacidosis (DKA) risks, no significant difference was found. However, marginally higher DKA risks were associated specifically with the use of Canagliflozin.
  • SGLT2 inhibitors like Canagliflozin are effective against Non-Alcoholic Fatty Liver Disease (NAFLD). They improve insulin sensitivity aiding weight loss while mitigating chronic inflammation, thus demonstrating renoprotective effects especially at lower doses of 100mg.
  • Canagliflozin, along with other SGLT2 inhibitors like dapagliflozin and empagliflozin, has shown beneficial effects in reducing cardiovascular disease mortality and hospital admission rates. This indicates a significant positive impact beyond glucose control.
  • An increased risk for Lower Limb Amputation (LLA) was observed specifically with Canagliflozin use amongst all SGLT2 inhibitors. Also, these drugs were associated generally with higher risks of Urinary Tract Infections (UTI) & genital tract infections.
  • Despite the benefits offered by Canagliflozin including improved glycemic control, better cardiovascular & renal outcomes as well as a good adherence profile compared to older antidiabetic agents; it also presents elevated risks for genital infections, UTIs, and particularly an increased risk of LLA associated with its use.

Product Monograph / Prescribing Information

Document TitleYearSource
Invokana (canagliflozin) Prescribing Information.2020Janssen Pharmaceuticals, Inc., Titusville NJ

Systematic Reviews / Meta-Analyses

Document TitleYearSource
Adherence to newer second-line oral antidiabetic drugs among people with type 2 diabetes-a systematic review.2024Pharmacology Research & Perspectives
Selective sodium-glucose cotransporter-2 inhibitors in the improvement of hemoglobin and hematocrit in patients with type 2 diabetes mellitus: A network meta-analysis.2024Frontiers in Endocrinology
Safety of sodium-glucose cotransporter 2 inhibitors in elderly patients with type 2 diabetes: A meta-analysis of randomized controlled trials. 2023Diabetes, Obesity & Metabolism
Neutral effects of SGLT2 inhibitors in acute coronary syndromes, peripheral arterial occlusive disease, or ischemic stroke: A meta-analysis of randomized controlled trials.2023Cardiovascular Diabetology
Risk of diabetic ketoacidosis of SGLT2 inhibitors in patients with type 2 diabetes: A systematic review and network meta-analysis of randomized controlled trials.2023Frontiers in Pharmacology
The effects of sodium-glucose cotransporter 2-inhibitors on steatosis and fibrosis in patients with non-alcoholic fatty liver disease or steatohepatitis and type 2 diabetes: A systematic review of randomized controlled trials.2023Medicina
Dose-dependent renoprotection efficacy of sglt2 inhibitors in type 2 diabetes: Systematic review and network meta-analysis.2023Acta Diabetologica
The efficacy of sodium-glucose cotransporter-2 inhibitors in improving morbidity and mortality of heart failure: A systematic review.2023Cureus
Safety of sodium-glucose transporter 2 (SGLT-2) inhibitors in patients with type 2 diabetes: A meta-analysis of cohort studies. 2023Frontiers in Pharmacology
Prevalence of sodium-glucose transporter 2 inhibitor-associated diabetic ketoacidosis in real-world data: A systematic review and meta-analysis. 2023Frontiers in Pharmacology
Comparative efficacy and safety of sodium-glucose cotransporter 2 inhibitors for renal outcomes in patients with type 2 diabetes mellitus: A systematic review and network meta-analysis. 2023Renal Failure
Comparative safety of different sodium-glucose transporter 2 inhibitors in patients with type 2 diabetes: A systematic review and network meta-analysis of randomized controlled trials. 2023Frontiers in Endocrinology
Clinical efficacy of different doses of canagliflozin combined with metformin in the treatment of type 2 diabetes: Meta-analysis.2023Alternative Therapies in Health and Medicine
Serum uric acid lowering and effects of sodium-glucose cotransporter-2 inhibitors on gout: A meta-analysis and meta-regression of randomized controlled trials.2023Diabetes, Obesity & Metabolism
Comparative cardiovascular benefits of individual SGLT2 inhibitors in type 2 diabetes and heart failure: A systematic review and network meta-analysis of randomized controlled trials.2023Frontiers in Endocrinology
Comparative safety of different recommended doses of sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes mellitus: A systematic review and network meta-analysis of randomized clinical trials.2023Frontiers in Endocrinology
Impact of SGLT2 inhibitors on patient outcomes: A network meta-analysis.2023Cardiovascular Diabetology
The effect of sodium-glucose co-transporter-2 (SGLT2) inhibitors on blood interleukin-6 concentration: A systematic review and meta-analysis of randomized controlled trials.2023BMC Endocrine Disorders
Treatments for chronic kidney disease: A systematic literature review of randomized controlled trials.2022Advances in Therapy
Association of SGLT2 inhibitors with risk of atrial fibrillation and stroke in patients with and without type 2 diabetes: A systemic review and meta-analysis of randomized controlled trials. 2022Journal of Cardiovascular Pharmacology
Comparative cardiovascular outcomes of SGLT2 inhibitors in type 2 diabetes mellitus: a network meta-analysis of randomized controlled trials. 2022Frontiers in Endocrinology
Comparative efficacy of five SGLT2i on cardiorenal events: a network meta-analysis based on ten CVOTs.2022American Journal of Cardiovascular Drugs
Impacts of sodium/glucose cotransporter-2 inhibitors on circulating uric acid concentrations: A systematic review and meta-analysis. 2022Journal of Diabetes Research
Sodium-glucose cotransporter-2 inhibitors and risk of diabetic ketoacidosis among adults with type 2 diabetes: A systematic review and meta-analysis.2022Canadian Journal of Diabetes
Euglycemic diabetic ketoacidosis associated with SGLT2 inhibitors: A systematic review and quantitative analysis. 2022Journal of Family Medicine and Primary Care
Renal protective effect and safety of sodium-glucose cotransporter-2 inhibitors in patients with chronic kidney disease and type 2 diabetes mellitus: A network meta-analysis and systematic review.2022International Urology and Nephrology
Canagliflozin and atrial fibrillation in type 2 diabetes mellitus: A secondary analysis from the CANVAS Program and CREDENCE trial and meta-analysis.2022Diabetes, Obesity & Metabolism
Cardiovascular and renal outcomes with sodium glucose co-transporter 2 inhibitors in patients with type 2 diabetes mellitus: A system review and network meta-analysis.2022Frontiers in Pharmacology
SGLT2 inhibitors for the composite of cardiorenal outcome in patients with chronic kidney disease: A systematic review and meta-analysis of randomized controlled trials.2022European Journal of Pharmacology
Comparison the effects of finerenone and SGLT2i on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus: A network meta-analysis.2022Frontiers in Endocrinology
Dose-ranging effects of SGLT2 inhibitors in patients with type 2 diabetes: A systematic review and meta-analysis.2022Archives of Endocrinology and Metabolism
Influence of receptor selectivity on benefits from SGLT2 inhibitors in patients with heart failure: A systematic review and head-to-head comparative efficacy network meta-analysis.2022Clinical Research in Cardiology
Effects of different doses of canagliflozin on blood pressure and lipids in patients with type 2 diabetes: A meta-analysis.2022Journal of Hypertension
Effects of sodium/glucose cotransporter 2 (SGLT2) inhibitors and combined SGLT1/2 inhibitors on cardiovascular, metabolic, renal, and safety outcomes in patients with diabetes: A network meta-analysis of 111 randomized controlled trials.2022American Journal of Cardiovascular Drugs
Semaglutide for the treatment of type 2 Diabetes Mellitus: A systematic review and network meta-analysis of safety and efficacy outcomes.2022Diabetes & Metabolic Syndrome
Effects of canagliflozin on major adverse cardiovascular events by baseline estimated glomerular filtration rate: Pooled Hispanic subgroup analyses from the CANVAS Program and CREDENCE trial.2022Diabetes, Obesity & Metabolism
Effects of sodium-glucose cotransporter 2 inhibitors on serum uric acid in patients with type 2 diabetes mellitus: A systematic review and network meta-analysis.2022Diabetes, Obesity & Metabolism
Microvascular benefits of new antidiabetic agents: a systematic review and network meta-analysis of kidney outcomes.2021The Journal of Endocrinology & Metabolism
Comparative efficacy of 5 sodium glucose cotransporter 2 inhibitor and 7 glucagon-like peptide 1 receptor agonists interventions on cardiorenal outcomes in type 2 diabetes patients.2021Medicine
Association of SGLT2 inhibitors with arrhythmias and sudden cardiac death in patients with type 2 diabetes or heart failure: a meta-analysis of 34 randomized controlled trials.2021Heart Rhythm
Comparative efficacy of dual and single initiation of add-on oral antihyperglycemic agents in type 2 diabetes uncontrolled on metformin alone: a systematic literature review and network meta-analysis.2021Diabetes Therapy
Effect of SGLT-2 inhibitors on non-alcoholic fatty liver disease among patients with type 2 diabetes mellitus: systematic review with meta-analysis and trial sequential analysis of randomized clinical trials.2021Oman Medical Journal
Protective effects of sodium-glucose transporter 2 inhibitors on atrial fibrillation and atrial flutter: a systematic review and meta- analysis of randomized placebo-controlled trials.2021Frontiers in Endocrinology
Sodium-glucose cotransporter 2 inhibitors, all-cause mortality, and cardiovascular outcomes in adults with type 2 diabetes: a Bayesian meta-analysis and meta-regression.2021Journal of the American Heart Association
High-dose sodium-glucose co-transporter-2 inhibitors are superior in type 2 diabetes: a meta-analysis of randomized clinical trials.2021Diabetes, Obesity and Metabolism
Comparative efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) for cardiovascular outcomes in type 2 diabetes: a systematic review and network meta-analysis of randomised controlled trials.2021Heart Failure Reviews
Comparative efficacy of glucose-lowering medications on bodyweight and blood pressure in patients with type 2 diabetes: a systematic review and network meta-analysis.2021Diabetes, Obesity and Metabolism
Safety and efficacy of SGLT2 inhibitors: a multiple-treatment meta-analysis of clinical decision indicators.2021Journal of Clinical Medicine
Comparison of the effects of 10 GLP-1 RA and SGLT2 inhibitor interventions on cardiovascular, mortality, and kidney outcomes in type 2 diabetes: a network meta-analysis of large randomized trials.2021Primary Care Diabetes
Gliflozins for the prevention of stroke in diabetes and cardiorenal diseases.2021Medicine
Sodium-glucose co-transporter 2 inhibitors (SGLT2i) exposure and outcomes in type 2 diabetes: A systematic review of population-based observational studies.2021Diabetes Therapy
Safety of four SGLT2 inhibitors in three chronic diseases: A meta-analysis of large randomized trials of SGLT2 inhibitors.2021Diabetes & Vascular Disease Research
Effect of sodium-dependent glucose transporter inhibitors on glycated hemoglobin A1c after 24 weeks in patients with diabetes mellitus: A systematic review and meta-analysis.2021Medicine
Canagliflozin for prevention of cardiovascular and renal outcomes in type2 diabetes: A systematic review and meta-analysis of randomized controlled trials.2021Frontiers in Pharmacology
Sodium-glucose co-transporter-2 inhibitors for the prevention of cardiorenal outcomes in type 2 diabetes: An updated meta-analysis.2021Diabetes, Obesity & Metabolism
SGLT-2 inhibitors and cardiorenal outcomes in patients with or without type 2 diabetes: a meta-analysis of 11 CVOTs.2021Cardiovascular Diabetology
Comparing the clinical outcomes across different sodium/glucose cotransporter 2 (SGLT2) inhibitors in heart failure patients: a systematic review and network meta-analysis of randomized controlled trials.2021European Journal of Clinical Pharmacology
Comparative efficacy of glucagon-like peptide 1 receptor agonists and sodium glucose cotransporter 2 inhibitors for prevention of major adverse cardiovascular events in type 2 diabetes: A network meta-analysis.2021Journal of Cardiovascular Pharmacology
Meta-analysis of dedicated renal outcome trials assessing the cardio-renal efficacy of sodium-glucose co-transporter-2 inhibitors in patients with chronic kidney disease and albuminuria.2021American Journal of Cardiology
Comparative effectiveness of glucose-lowering drugs for type 2 diabetes: A systematic review and network meta-analysis. 2020Annals of Internal Medicine
Cardiovascular outcomes with the use of sodium-glucose cotransporter-2 inhibitors in patients with type 2 diabetes and chronic kidney disease: An updated meta-analysis of randomized controlled trials. 2020Cardiology in Review
Efficacy and safety of SGLT-2 inhibitors for treatment of diabetes mellitus among kidney transplant patients: A systematic review and meta-analysis.2020Medical Sciences
Risk of amputation associated with sodium-glucose co-transporter 2 inhibitors: A meta-analysis of five randomized controlled trials. 2020Diabetes Research and Clinical Practice
Clinical Adverse Events of High-Dose vs Low-Dose Sodium-Glucose Cotransporter 2 Inhibitors in Type 2 Diabetes: A Meta-Analysis of 51 Randomized Clinical Trials.2020Journal of Endocrinology and Metabolism
The effects of SGLT2 inhibitors on cardiovascular and renal outcomes in diabetic patients: A systematic review and meta-analysis.2020Cardiorenal Medicine
Ertugliflozin compared to other anti-hyperglycemic agents as monotherapy and add-on therapy in type 2 diabetes: A systematic literature review and network meta-analysis.2019Diabetes Therapy
Peripheral artery disease and amputations with sodium-glucose co-transporter-2 (SGLT-2) inhibitors: A meta-analysis of randomized controlled trials .2019Diabetes Research and Clinical Practice
SGLT2 inhibitors for the prevention of kidney failure in patients with type 2 diabetes: A systematic review and meta-analysis.2019The Lancet Diabetes & Endocrinology
Effects of SGLT2 inhibitors on cardiovascular outcomes and mortality in type 2 diabetes: A meta-analysis.2019Medicine
Acute kidney injury and adverse renal events in patients receiving SGLT2-inhibitors: A systematic review and meta-analysis.2019PLoS Medicine

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