A recent study showed patients with type 2 diabetes did better if given the combination therapy at the outset than if given 1 of the components as monotherapy.
The combination diabetes therapy Invokamet, a fixed-dose of canagliflozin (Invokana) and metformin, now has FDA approval as a first-line therapy, according to statement from the drug’s manufacturer, Janssen Pharmaceuticals.
“With this new approval, Invokamet may now be prescribed in adults with type 2 diabetes (T2D) who are not already being treated with canagliflozin or metformin and may benefit from dual therapy,” the statement said.
The drug, first approved in August 2014, is the first combination of an SGLT2 inhibitor and metformin available in the United States. Canagliflozin was the first of the class of sodium-glucose co-transporter-2 (SGLT2) inhibitors approved by FDA in 2013.
Until now, Invokamet could be prescribed only for patients who were not achieving blood glucose targets on either canagliflozin or metformin, or for T2D adults who were already being treated on the drugs separately. Using combination therapy from the start allows patients to get the benefits of both medications while taking 1 pill, which may improve adherence.
Metformin has long been the standard first-line therapy for T2D; however, new treatment guidelines from the American Diabetes Association call for using combination therapy from the start for patients with more elevated levels of glycated hemoglobin (A1C).1
A phase 3 study published in Diabetes Care in March found that among patients not taking any therapy to reduce A1C, those given the combination therapy at the outset had greater A1C reductions than those given either dose of canagliflozin (100 mg or 300 mg) or metformin separately.2
After 26 weeks, researchers reported the following A1C reductions:
· Combination therapy with 100 mg of canagliflozin: A1C reduced 1.77%
· Combination therapy with 300 mg of canagliflozin: A1C reduced 1.78%
· Monotherapy of 100 mg canagliflozin: A1C reduced 1.37%
· Monotherapy of 300 mg canagliflozin: A1C reduced 1.42%
· Monotherapy of metformin: A1C reduced 1.3%
Also, after 26 weeks, a higher share of patients given the combination therapy than those in the monotherapy groups achieved an A1C of less than 7%: 47% for the combination with 100 mg canagliflozin, 51% for those taking the combo with 300 mg canagliflozin vs 38% for the metformin group.
“Physicians increasingly try to achieve greater blood sugar control by using dual therapy at the outset, versus single-agent therapy alone, especially for patients with higher A1C levels,” said John Anderson, MD, of the Frist Clinic in Nashville, Tennessee, in the Janssen statement. Invokamet, he said, “combines 2 effective, complementary medicines—canagliflozin and metformin—into 1 convenient pill, to lower A1C significantly more than metformin alone.”
RELATED COVERAGE: Real-world data on canagliflozin in a managed care setting
References
1. American Diabetes Association. Glycemic targets, Section 5. Standard of Medical Care in Diabetes—2016. Diabetes Care. 2016;39(suppl1): S39-S46.
2. Rosenstock J, Chuck L, Gonzales-Ortiz M, et al. Initial combination therapy with canagliflozin plus metformin versus each component as monotherapy for drug-naïve type 2 diabetes. Diabetes Care. 2016;39(3):353-362.
Beyond Insulin: The Impact of Next-Generation Diabetes Technology
April 17th 2024Experts explain how new diabetes technologies like continuous glucose monitors are transforming care beyond intensive insulin therapy, offering personalized insights and improving outcomes for patients of all treatment levels.
Read More
How Can Employers Leverage the DPP to Improve Diabetes Rates?
February 15th 2022On this episode of Managed Care Cast, Jill Hutt, vice president of member services at the Greater Philadelphia Business Coalition on Health, explains the Coalition’s efforts to reduce diabetes rates through the Diabetes Prevention Program (DPP).
Listen
Balancing Care Access and Fragmentation for Better Outcomes in Veterans With Diabetes
April 22nd 2021The authors of a study in the April 2021 issue of The American Journal of Managed Care® discuss the possible reasons behind the link between care fragmentation and hospitalizations in veterans with diabetes, as well as potential opportunities to address disjointed care in the context of the widespread telehealth uptake seen during the COVID-19 pandemic.
Listen