A real-world analysis of glycemic control among patients with type 2 diabetes treated with canagliflozin versus dapagliflozin

Abstract

<p><b>Objective:</b> This US retrospective cohort study compared the real-world effectiveness of canagliflozin 300 mg versus dapagliflozin 10 mg on HbA1c reduction in patients with type 2 diabetes mellitus (T2DM).</p> <p><b>Methods:</b> Patients initiated on canagliflozin 300 mg or dapagliflozin 10 mg were identified from de-identified claims data in the Optum Clinformatics database (1 January 2014–30 September 2016). Propensity score matching was used to create balanced cohorts. The primary outcome was the proportion of patients with HbA1c <8.0% (HEDIS target); secondary outcomes included the proportion of patients with HbA1c <7.0% (ADA target) and >9.0% (HEDIS poor control), absolute change in HbA1c, and treatment patterns.</p> <p><b>Results:</b> At 6 months post-index (intent-to-treat population), a significantly higher proportion of patients in the canagliflozin 300 mg versus dapagliflozin 10 mg cohort achieved HbA1c <8.0% (70.8% vs. 59.1%; OR [95% CI]: 1.60 [1.26, 2.04]; <i>p</i> = .0001) and HbA1c <7.0% (36.7% vs. 25.1%; OR [95% CI]: 1.75 [1.34, 2.27]; <i>p</i> < .0001). A similar proportion of patients had HbA1c >9.0%. Mean HbA1c reduction was −1.17% with canagliflozin 300 mg and −0.91% with dapagliflozin 10 mg (difference of −0.26%; <i>p</i> = .0049). HbA1c results from a sensitivity analysis in the on-treatment population were consistent with the primary analysis. Patients in the canagliflozin 300 mg versus dapagliflozin 10 mg cohort were less likely to discontinue treatment (OR [95% CI]: 0.75 [0.57, 0.99]; <i>p</i> = .0400) or switch medication (OR [95% CI]: 0.72 [0.54, 0.96]; <i>p</i> = .0229).</p> <p><b>Conclusions:</b> In this real-world study, patients with T2DM initiated on canagliflozin 300 mg had better HbA1c goal attainment and larger HbA1c reduction than patients initiated on dapagliflozin 10 mg.</p