Effects of the sodium-glucose co-transporter 2 inhibitor dapagliflozin in patients with type 2 diabetes and Stages 3b-4 chronic kidney disease.
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ABSTRACT: Background:The sodium-glucose co-transporter 2 inhibitor dapagliflozin decreases haemoglobin A1c (HbA1c), body weight, blood pressure (BP) and urinary albumin:creatinine ratio (UACR) in patients with type 2 diabetes. The efficacy and safety of this drug have not been properly defined in patients with type 2 diabetes and Stages 3b-4 chronic kidney disease (CKD). Methods:In a pooled analysis of 11 phase 3 randomized controlled clinical trials, we determined least square mean changes in HbA1c, body weight, BP, estimated glomerular filtration rate (eGFR) and UACR over 102?weeks in patients with type 2 diabetes and an eGFR between 12 to less than 45?mL/min/1.73 m2 receiving placebo (n?=?69) or dapagliflozin 5 or 10?mg (n?=?151). Effects on UACR were determined in a subgroup of patients with baseline UACR??30?mg/g (n?=?136). Results:Placebo-corrected changes in HbA1c with dapagliflozin 5 and 10?mg were 0.03% [95% confidence interval (CI) -0.3-0.3] and 0.03% (95% CI -0.2-0.3) during the overall 102-week period. Dapagliflozin 5 and 10?mg compared with placebo reduced UACR by?-?47.1% (95% CI -64.8 to?-?20.6) and -38.4% (95% CI -57.6 to?-?10.3), respectively. Additionally, dapagliflozin 5 and 10?mg compared with placebo reduced BP and body weight. eGFR increased with placebo during the first 4?weeks but did not change with dapagliflozin. There were no between-group differences in eGFR at the end of follow-up. Adverse events associated with renal function occurred more frequently in the dapagliflozin 10-mg group. These events were mainly asymptomatic increases in serum creatinine. Conclusions:Dapagliflozin did not decrease HbA1c in patients with type 2 diabetes and Stages 3b-4 CKD, but decreased UACR, BP and body weight to a clinically meaningful extent. These results support a large outcome trial in this population to confirm long-term safety and efficacy in reducing adverse clinical endpoints.
SUBMITTER: Dekkers CCJ
PROVIDER: S-EPMC6212718 | biostudies-literature | 2018 Nov
REPOSITORIES: biostudies-literature
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