PracticeUpdate Conference Series ISN WCN 2019

CREDENCE Shows Safety and Efficacy of Canagliflozin for Renal Endpoints in Type 2 Diabetes Benefits in cardiovascular outcomes were also demonstrated.

T he SGLT2 inhibitor canagliflozin effectively reduces the risk of renal and cardiovascular events in patients with type 2 diabetes and chronic kidney disease, even those with con- siderably poor renal function, according to the CREDENCE trial. The background, study design, findings and clinical implications of CREDENCE were each presented by different members of the study’s steering committee. “There has been a huge increase in those going on to end-stage kidney disease (ESKD), espe- cially since the 1990s, but that trend started back in the 1980s,” said George Bakris, MD, from the University of Chicago, during his presentation on the background of CREDENCE. “… If you project out to 2030, there is going to be a doubling of renal replacement therapy around the world that is going to be needed. This is particularly important to certain regions of the world, such as Asia and North America. “This is a problem that is not going away,” he added. “It is getting worse, and we really need some inroads on it. Diabetes is by far the leading cause of people requiring renal replacement therapy,

and this problem is also headed for much bigger numbers, so this is a huge epidemic with major consequences.” SGLT2s, he continued “… reduce intraglomerular pressure, they affect atrial natriuretic peptide, they reduce albuminuria, … [they reduce] oxidant stress within the diabetic kidney, and [they produce] dramatic blunting of angiotensinogen within the diabetic kidney. And they have other mechanisms dealing with anti-fibrotic and anti-inflammatory effects.” While previous trials of SGLT2 inhibitors have shown promise with regard to their effects on the kidney, these trials were not primarily designed to evaluate renal effect, so few patients were included who had substantial nephropathy. The primary goal of CREDENCE, however, was to “assess the effects of the SGLT2 inhibitor canagli- flozin on clinically important outcomes in people with type 2 diabetes and established chronic kid- ney disease,” said Dr. Bakris. For the trial, which was sponsored by Janssen, manufacturers of canagliflozin, 4401 patients from 34 countries with type 2 diabetes and an estimated

Dr. George Bakris

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PRACTICEUPDATE CONFERENCE SERIES • WCN 2019