Efficacy and safety of replacing sitagliptin with canagliflozin in real-world patients with type 2 diabetes uncontrolled with sitagliptin combined with metformin and/or gliclazide: The SITA-CANA Switch Study

Aim

To analyze the efficacy and safety of replacing sitagliptin with canagliflozin in patients with type 2 diabetes (T2D) and poor metabolic control despite treatment with sitagliptin in combination with metformin and/or gliclazide.

Materials and methods

In this multicentre observational, retrospective, 26-week clinical study of patients with T2D and poor glycaemic control (HbA1c: 7.5–9.5%) treated with sitagliptin in combination with metformin and/or gliclazide, sitagliptin (and gliclazide if appropriate) were replaced by canagliflozin. The main outcome of the study was the proportion of patients who achieved good glycaemic control (HbA1c < 7%) by the end of the study.

Results

The study sample comprised 50 patients (baseline HbA1c 8.0 ± 0.6%) treated with sitagliptin 100 mg/day, 14 of whom were also taking gliclazide 60 mg/day while 38 were taking metformin 1700 mg/day. Sitagliptin treatment was replaced by either canagliflozin 100 mg (n = 17) or 300 mg (n = 33). After 26 weeks of follow-up, these patients presented with significant decreases in HbA1c (?1.1%; P < 0.000), weight (?3.89 kg; P < 0.000), BMI (?1.37 kg/m²; P < 0.022), abdominal circumference (?5.42 cm; P < 0.004), systolic and diastolic blood pressure (?5.3 mmHg and ?4.4 mmHg, respectively; P = 0.005), triglycerides (?42 mg/dL; P = 0.005) and LDL/HDL cholesterol ratio (?0.34; P = 0.005). By the end of the study, 42% of patients had achieved HbA1c levels < 7%.

Conclusion

In patients with T2D poorly controlled with sitagliptin, whether alone or in combination with metformin and/or gliclazide, replacing it with canagliflozin may be a simple yet effective intensification strategy. Our results, which may have important implications for clinical practice, now need to be confirmed in larger observational studies.