カナグリフロジン(商品名:カナグル)存亡の危機?
心血管高リスク・2型糖尿病患者対象の2つのトライアル
総数10,142名の高心血管リスク2型糖尿病
ランダムにカナグリフロジン vs プラシーボ
平均188.2週間フォローアップ
Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes
Bruce Neal, et al. , for the CANVAS Program Collaborative Group
June 12, 2017DOI: 10.1056/NEJMoa1611925
http://www.nejm.org/doi/full/10.1056/NEJMoa1611925
下肢切断リスクと心血管イベント減少効果ベネフィット
プライマリアウトカム<心血管死亡・非致死性MI、非致死性卒中>
1000人年 26.9 vs 31.5 ;ハザード比 0.86 ; 95% 信頼区間 [CI], 0.75 to 0.97
下肢切断リスク
1000人年 6.3 vs 3.4 ;ハザード比 1.97 ; 95% 信頼区間 [CI], 1.41 to 2.75
-->
Table 2. Adverse Events.* |
|
|
|
Event |
Canagliflozin |
Placebo |
P Value}- |
|
event rate per 1000 patient-yr |
|
All serious adverse events |
104. |
120.0 |
0.04 |
Adverse events leading to discontinuation |
36. |
33. |
0.07 |
Serious and nonserious adverse events of
interest
recorded in the CANVAS Program |
|
|
|
Acute pancreatitis (adjudicated) |
0.5 |
0.4 |
0.63 |
Cancer |
|
|
|
Renal cell |
0.6 |
0.2 |
0.17 |
Bladder |
1.0 |
1. |
0.74 |
Breast |
3. |
3. |
0.65 |
Photosensitivity |
1.0 |
0.3 |
0.07 |
Diabetic ketoacidosis (adjudicated) |
0.6 |
0.3 |
0.14 |
Amputation |
6. |
3. |
<0 .001="" font="">0> |
Fracture (adjudicated)* |
|
|
|
All |
15. |
12. |
0.02 |
Low-trauma |
12. |
9. |
0.06 |
Venous thromboembolic events |
2. |
2. |
0.63 |
Infection of male genitaliaS |
35. |
11. |
<0 .001="" font="">0> |
Serious and nonserious adverse events of
interest collected in CANVAS alone |
|
|
|
Osmotic diuresis |
35. |
13. |
<0 .001="" font="">0> |
Volume depletion |
26.0 |
19. |
0.009 |
Hypoglycemia |
50.0 |
46. |
0.20 |
Acute kidney injury |
3.0 |
4. |
0.33 |
Hyperkalemia |
7. |
4. |
0.10 |
Urinary tract infection |
40.0 |
37.0 |
0.38 |
Mycotic genital infection in women |
69. |
18. |
<0 .001="" font="">0> |
Severe hypersensitivity or cutaneous
reaction |
9. |
6. |
0.17 |
Hepatic injury |
7. |
9. |
0.35 |
Renal-related (including acute kidney
injury) |
20. |
17. |
0.32 |
* Analyses were performed on data from the on-treatment data set (patients who had a safety outcome while they were receiving canagliflozin or placebo or within 30 days after discontinuation of the drug or placebo), except for fracture, amputation, cancer, and diabetic ketoacidosis outcomes, which included all events at any time point in all patients who underwent randomization and received at least one dose of canagliflozin or placebo. P values were estimated from Cox regression models.