Dapagliflozin versus saxagliptin as add-on therapy in patients with type 2 diabetes inadequately controlled with metformin

• Published in: Archives of Endocrinology and Metabolism Vol. 62; no. 4; pp. 424 - 430
• Main Authors: Rosenstock, Julio, Mathieu, Chantal, Chen, Hungta, Garcia-Sanchez, Ricardo, Saraiva, Gabriela Luporini
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Endocrinologia e Metabologia 01-08-2018; Brazilian Society of Endocrinology and Metabolism
• Subjects: Adamantane - adverse effects; Adamantane - analogs & derivatives; Adamantane - therapeutic use; Benzhydryl Compounds - adverse effects; Benzhydryl Compounds - therapeutic use; Blood Glucose - drug effects; Blood Pressure - drug effects; Body Weight - drug effects; Dapagliflozin; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Dipeptides - adverse effects; Dipeptides - therapeutic use; Dipeptidyl-Peptidase IV Inhibitors - adverse effects; Dipeptidyl-Peptidase IV Inhibitors - therapeutic use; Double-Blind Method; Drug Therapy, Combination - methods; Female; Glucosides - adverse effects; Glucosides - therapeutic use; Glycated Hemoglobin - drug effects; Humans; Hypoglycemia - chemically induced; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Male; Metformin - adverse effects; Metformin - therapeutic use; Middle Aged; Original; Reproductive Tract Infections - chemically induced; SGLT2 inhibitor; Sodium-Glucose Transporter 2 - adverse effects; Sodium-Glucose Transporter 2 - therapeutic use; Sodium-Glucose Transporter 2 Inhibitors; Treatment Outcome; type 2 diabetes
• ISSN: 2359-3997; 2359-4292; 2359-4292
• DOI: 10.20945/2359-3997000000056

This analysis compared the efficacy and safety of the sodium-glucose cotransporter-2 (SGLT2) inhibitor, dapagliflozin, and the dipeptidyl peptidase-4 (DPP4) inhibitor, saxagliptin, both added on to metformin.
This was a post-hoc analysis from a double-blind, randomized, 24-week clinical trial (NCT01606007) of patients with type 2 diabetes (T2D) inadequately controlled with metformin. We compared the dapagliflozin 10 mg (n = 179) and saxagliptin 5 mg (n = 176) treatment arms.
Dapagliflozin showed significantly greater mean reductions versus saxagliptin in HbA1c (difference versus saxagliptin [95% CI]: -0.32% [-0.54, -0.10]; p < 0.005), fasting plasma glucose (-0.98 [-1.42, -0.54] mmol/L; p < 0.0001), body weight (-2.39 [-3.08, -1.71] kg; p < 0.0001) and systolic blood pressure (SBP) (-3.89 [-6.15, -1.63] mmHg; p < 0.001). More dapagliflozintreated than saxagliptin-treated patients achieved the composite endpoint of HbA1c reduction ≥ 0.5%, weight loss ≥ 2 kg, SBP reduction ≥ 2 mmHg and no major/minor hypoglycemia (24% versus 7%). No major events of hypoglycemia were reported. More patients on dapagliflozin (6%) versus saxagliptin (0.6%) experienced genital infections.
Dapagliflozin demonstrated greater glycemic efficacy than saxagliptin with additional benefits on weight and SBP, and the safety profile was consistent with previous studies.