Type 2 diabetes is a frequent disease, especially in adults over the age of 40. Its treatment aims to avoid or delay the occurrence of severe, sometimes fatal complications. When behavioural and dietary measures are insufficient, only metformin has a reasonably well established efficacy in reducing diabetes mortality and complications. In the case of insufficient efficacy or overly severe adverse effects, it is preferable to resort to insulin, either alone or combined with an oral hypoglycaemic agent.

Canagliflozin has been authorised in the treatment of type 2 diabetes patients. Canagliflozin belongs to the same drug group as dapagliflozin, which has an unfavourable harm-benefit balance in type 2 diabetes.

Canagliflozin's evaluation shows no evidence that it is effective in preventing diabetes complications and its glucose-lowering effect is modest. Its adverse effects are similar to those of dapagliflozin, which are many and sometimes severe (urinary infections and genital fungal infections, arterial hypotension, dehydration, aggravations of kidney failure, drug interactions). Furthermore, there is still considerable uncertainty as to a cardiovascular risk. Evidence from animal trials suggest a risk of cancer, as well as bone mineralisation impairment, and so perhaps an increased risk of fractures.

Canagliflozin's harm-benefit balance, like that of dapagliflozin, is unfavourable. It is better to rule these two drugs out, their evaluation does not offer a strict enough guarantee to expose type 2 diabetes patients to their adverse effects for years. There are other, preferable options.

©Prescrire 1 February 2015

"Canagliflozin (Invokana°). A "me-too" of the dangerous dapagliflozin" Prescrire Int 2015; 24 (157): 33-35. (Pdf, subscribers only).