Issue 44 June 2012
6. Diabetes Medicine Updates
Diabetes drug Canagliflozin from J & J

A new type of diabetes drug being developed by a unit of Johnson & Johnson (Janssen) showed it reduced the measure of blood sugar in patients with type 2 diabetes. Janssen’s canagliflozin demonstrated substantial and sustained glycaemic improvements in five phase III studies of the SGLT2 inhibitor presented at the American Diabetes Association (ADA) meeting in Philadelphia. So far the U.S. Food and Drug Administration has refused to approve a similar drug, dapagliflozin, from Bristol-Myers Squibb Co. and AstraZeneca PLC and has asked the companies for more information to assess risks and benefits.

Canagliflozin is in a new class of drugs called sodium-glucose co-transporter-2 (SGLT2) inhibitors. Such drugs are designed to lower blood-glucose levels in patients with diabetes by increasing the amount of glucose excreted in the urine. The SGLT2 system is used by the kidneys to filter and reabsorb glucose circulating in the blood.

Two of the stand out trials showcased canagliflozin's potential as a monotherapy, comparing it to the current standard treatments of Januvia and Sanofi's Amaryl (glimepiride). Patients were given once-daily doses of canagliflozin (300mg) or Januvia (100mg) and those treated with canagliflozin had a "substantial and sustained decrease in A1C levels, with a significantly greater reduction relative to [Januvia] after 52 weeks," Janssen said. Adverse events were mild to moderate and the overall incidence was balanced across treatment arms. Adverse events related to osmotic diuresis such as increased urination, genital mycotic infections in men and women, and urinary tract infections were more frequent in patients treated with canagliflozin than glimepiride.

New Diabetes Drug Dulaglutide Lowers Blood Pressure
An investigational glucagon-like peptide-1 (GLP-1) agonist significantly reduced systolic blood pressure in patients with type 2 diabetes who were taking oral anti-hyperglycemic medications, a phase II trial showed. After 16 once-weekly injections of Dulaglutide 1.5 mg, 24-hour ambulatory systolic blood pressure was an average 2.8 mm Hg lower versus placebo (P<0.001), a difference sustained at the end of treatment at 26 weeks (2.7 mm Hg, P=0.002), according to Keith Ferdinand, MD, of Tulane University in New Orleans. At 16 weeks, treatment with the 0.75-mg and 1.5-mg doses of dulaglutide reduced 24-hour mean systolic blood pressure 1.07 mm Hg and 2.79 mm Hg, respectively, and both reductions met the primary end point of noninferiority compared with placebo. At 26 weeks, the reduction in systolic blood pressure with the 0.75-mg and 1.5-mg doses was 1.71 mm Hg and 2.66 mm Hg. The reduction in systolic blood pressure with the 1.5-mg dose was statistically superior to the change observed with placebo, but the changes in diastolic pressure were not statistically significant.
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