A review of the efficacy and safety of canagliflozin in elderly patients with type 2 diabetes.
OBJECTIVE
To review the efficacy and safety of canagliflozin (CAN) in elderly patients with type 2 diabetes mellitus (T2DM).


METHODS
Studies were identified using PubMed, International Pharmaceutical Abstracts, MEDLINE, Academic Search Premier, SCOPUS, and Google Scholar from 2011 to August 2013. The following key words were reviewed: canagliflozin, canagliflozin elderly, canagliflozin geriatrics, dapagliflozin, sodium glucose cotransporter 2 (SGLT2) inhibitors, and SGLT2 receptor inhibitors.


METHODS
Articles evaluating CAN for diabetes that were published in English and used human subjects were selected. Fifteen clinical trials were identified and evaluated.


METHODS
Of 15 identified articles, 2 articles, 2 published posters, and unpublished information from the manufacturer were chosen based on the mean age of the study subjects.


RESULTS
Evidence that elderly patients with T2DM have less A1C reduction with CAN is presented; the benefit on A1C is significant. Systolic blood pressure (SBP) and body weight reduction in the elderly were consistent with younger patients. Adverse effects such as increased urinary frequency, genital mycotic infections, and urinary tract infections may discourage the use of CAN in the elderly patient.


CONCLUSIONS
Treatment with CAN improves A1C levels, reduces SBP and body weight, and is overall well tolerated in older subjects with T2DM. Risks and benefits of treatment with CAN should be assessed in geriatric patients on a case-by-case basis. Safety in elderly patients was consistent with that of other phase 3 trials in the general population. Additional longterm cardiovascular studies are needed.
St. Vincent's Hospital, Birmingham, Alabama.
Lindsey K
LK
Elmore
McWhorter School of Pharmacy, Samford University.
Sara
S
Baggett
McWhorter School of Pharmacy, Samford University.
Jeffrey A
JA
Kyle
McWhorter School of Pharmacy, Samford University.
Jessica W
JW
Skelley
D000368:Aged; D000068896:Canagliflozin; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004347:Drug Interactions; D005960:Glucosides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D000068896:Canagliflozin; D005960:Glucosides; D006442:Glycated Hemoglobin; D000077203:Sodium-Glucose Transporter 2 Inhibitors; D013876:Thiophenes; C517652:hemoglobin A1c protein, human
ADE = Adverse drug event; AE = Adverse effects; AHA = Antihyperglycemic agent; AUC = Area under the curve; BMI = Body mass index; BP = Blood pressure; CAN = Canagliflozin; CKD = Chronic kidney disease; CV = Cardiovascular; Canagliflozin; DBP = Diastolic blood pressure; Diabetes; Elderly; FPG = Fasting plasma glucose; Geriatrics; HDL-C = High-density lipoprotein cholesterol; ITT = Intention-to-treat; LDL-C = Low-density lipoprotein cholesterol; SBP = Systolic blood pressure; SGLT2 = Sodium glucose cotransporter 2; SGLT2 inhibitor; SU = Sulfonylurea; T2DM = Type 2 diabetes mellitus; Type 2 diabetes; UGT = UDPglucuronosyl transferase; UTI = Urinary tract infection; eGFR = Estimated glomerular filtration rate