Efficacy and Safety of Canagliflozin Versus Glimepiride in Patients With Type 2 Diabetes Inadequately Controlled With Metformin (CANTATA-SU): 52 Week Results From a Randomised, Double-blind, Phase 3 Non-inferiority Trial
Lancet 2013;382:941–50 doi.org/10.1016/S0140-6736(13)60683-2
Metformin is the standard and preferred first-line drug for T2D, but to adequately manage hyperglycaemia after an initial period of lifestyle management and monotherapy, patients often need combination therapy to maintain glycaemic control. Many available agents cause weight gain and increase the risk of hypoglycaemia, but sodium-glucose co-transporter-2 inhibitors (SGLT2i) improve glycaemia by enhancing urinary glucose excretion.
CANTATA-52 was a 52-week, randomised, double-blind trial compared the efficacy and safety of canagliflozin 100 mg or 300 mg with glimepiride in 1,452 patients with T2D inadequately controlled with metformin. For the primary endpoint of HbA1c lowering, both canagliflozin doses were non-inferior to glimepiride, and the 300 mg was superior to glimepiride. Improvements were also seen in body weight, documented hypoglycaemic episodes, fasting plasma glucose, and blood pressure. The authors concluded that these findings support the use of canagliflozin as a viable treatment option for patients who do not achieve sufficient glycaemic control with metformin therapy.