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Lakeridge doctor says medicine a “game changer”

Recent clinical trial shows Invokana reduces risks for diabetes patients with high cardiovascular risks

By Dave Flaherty/The Oshawa Express

Recently released research shows a class of medicine can significantly reduce the chance of severe cardiovascular events in patients with Type 2 diabetes.

Canaglifozin, known under the brand name of Invokana, is a drug used in the treatment of the disease.

It is a subtype 2-sodium transport (SGLT-2) inhibitor.

The medication works to lower blood sugar by encouraging the kidneys to release excess sugar through urine into the bladder.

Dr. Andrew Steele, Medical Director and Section Chief of Nephrology and Diabetes at Lakeridge Health, says that canagliflozin has been used in diabetes treatment for a few years now along with other factors such as controlling blood sugar and blood pressure, smoking cessation, diet, and exercise.

Invokana was approved by Health Canada on May 23, 2014.

However, Steele says clinical research released in October shows there are added benefits to the drug.

According to Steele, those with Type 2 diabetes are about two to four times more likely to have cardiovascular disease than the general public. They are also at a higher risk of suffering a heart attack, heart failure or stroke.

He says clinical trials, known as the CANVAS program, have shown that canagliflozin can reduce risks of these conditions in patients.

The CANVAS Program evaluated a total of 10,142 patients across 30 countries including Canada.

According to the outcomes of the program, patients experienced a 33 per cent reduction in hospitalization due to heart failure.

In patients with established cardiovascular disease, treatment with Invokana reduced the combined risk of cardiovascular death, non-fatal myocardial infarction and non-fatal stroke by 18 per cent.

“It’s a very important breakthrough,” Steele says, noting more than half the Type 2 diabetes patients he treats use the medication. “If you have a history of cardiovascular disease or a high-risk patient, this is the type of drug that would be added onto first-line therapy.”

Steele says this is the first medication that has been shown through research to have these effects.

In the past, he says other diabetes medications have actually increased the risk of cardiovascular disease, heart attack, and stroke.

The outcomes of the CANVAS Program also indicated an increase in the risk of limb amputation.

The risk was highest in patients with a history of prior amputation, peripheral vascular disease, and neuropathy.

Invokana is covered by the Ontario Drug Benefit Program and costs about $2.50 a day in Ontario. In comparison, it costs around $10 a day in the U.S., Steele says.

As with any medication, there are reported side effects, including vaginal yeast infection, hypoglycemia, yeast infection of the penis, urinary tract infection, increased urination, constipation, skin ulcers, nausea, and thirst.

Steele says it is a medication that should be started on a low dosage, and gradually increased.

“If you start on a high dose, you’ll get more adverse events,” he says.

But overall, Steele says it is a drug that is “exceedingly well-tolerated.”

He warns that it is not appropriate for those who have Type 1 diabetes, kidneys that are functioning at less than 30 per cent or dialysis patients.

In addition to his duties at Lakeridge, Steele is also the medical lead for the Ontario Renal Network in the Central East LHIN, past-president of the Toronto Regional Dialysis Committee, and has written guidelines for the Canadian Diabetes Association and the Canadian Society of Nephrology.

He says the newest information on canagliflozin is a “game changer.”

“It’s really a paradigm shift in diabetes treatment.”