Summary

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• Invokana (canagliflozin) is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus; to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus and established cardiovascular disease; and 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.
• This summary is based on the review of 69 systematic review(s)/meta-analysis(es). ^[1-70]
• Adherence rates for Canagliflozin, an SGLT2 inhibitor, ranged from 61.7% to 94.9% based on medication possession ratio, with treatment discontinuation within the first 12 months varying between 29% and 44%.
• Canagliflozin (100 mg and 300 mg) increased hematocrit and hemoglobin levels, with the 100 mg dose being most effective for hematocrit, and the 300 mg dose showing the greatest effect on hemoglobin.
• Significant reductions in cardiovascular mortality, heart failure hospitalizations, and renal composite outcomes were observed with Canagliflozin, along with improved outcomes in patients with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH).
• Canagliflozin demonstrated a significant reduction in gout risk in patients with type 2 diabetes mellitus (T2DM) or heart failure (HF).
• Adverse effects of Canagliflozin included increased risks of genital tract infections, urinary tract infections, diabetic ketoacidosis, lower limb amputation, and bone fractures.
• Higher incidence of genital tract infections was observed with Canagliflozin compared to other SGLT2 inhibitors.
• Canagliflozin was associated with a reduced risk of acute kidney injury in elderly patients but had a similar risk of volume depletion compared to other SGLT2 inhibitors.
• There was a noted increased risk of lower limb amputation with Canagliflozin, which warrants further investigation.
• Elderly patients (≥ 65 years) demonstrated lower discontinuation rates and fewer acute kidney injuries with Canagliflozin compared to younger cohorts, but had a higher risk of genital infections.
• Patients with chronic kidney disease, particularly those with a baseline eGFR <60 mL/min/1.73 m², experienced significant renal protection with Canagliflozin, though some studies indicated an increased risk of lower limb amputation in this subgroup.