SGLT-2 inhibitors and their potential in the treatment of diabetes
SGLT-2 Inhibitors A New Modality for Treating Type 2 Diabetes David Joffe BSPharm, CDE, Clinical...
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Transcript of SGLT-2 Inhibitors A New Modality for Treating Type 2 Diabetes David Joffe BSPharm, CDE, Clinical...
![Page 1: SGLT-2 Inhibitors A New Modality for Treating Type 2 Diabetes David Joffe BSPharm, CDE, Clinical Assistant Professor of Pharmacotherapy and Translational.](https://reader035.fdocuments.us/reader035/viewer/2022062408/56649eea5503460f94bfbace/html5/thumbnails/1.jpg)
SGLT-2 Inhibitors
A New Modality for Treating Type 2 Diabetes
David Joffe BSPharm, CDE, Clinical Assistant Professor of Pharmacotherapy and Translational Research Courtney Glanzrock, PharmD Candidate University of Florida College of Pharmacy
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Two sodium glucose transporters, cause glucose reabsorption, have been identified: SGLT-1 and SGLT-2
SGLT-2 is found only in the proximal tubule of the kidney, accounts for 90% of the re-absorption of glucose
SGLT-1 is found in the gut and other tissues, account for approximately 10% of glucose reabsorption
SGLT-1 and SGLT-2
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Invokana (Canagliflozin) 1st SGLT-2 inhibitor, approved March 2013
Once daily dosing before 1st meal of day, 100mg or 300mg tablets
MOA: Inhibition of SGLT2 reduces reabsorption of glucose in the kidney, resulting in increased urinary glucose excretion, with a consequent lowering of plasma glucose levels as well as weight loss.
Blocks approximately 50-80 grams of glucose per day from being reabsorbed
SGLT-2 Inhibitor - Canagliflozin
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SGLT2-I
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Positive effects: Reduction in body weight and systolic blood pressure
Side effects: Most common: Vaginal yeast infection, urinary tract infection and increased urination. Hypoglycemia (<5%), dehydration, dizziness or fainting, hyperkalemia
Contraindications: Clinicians should not use canagliflozin to treat patients with type 1 diabetes, patients with type 2 diabetes who have increased ketones in their blood or urine, severe renal impairment, end-stage renal disease or patients receiving dialysis
SGLT-2 Inhibitor-Canagliflozin
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SGLT-2 InhibitorFirst In Class
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Canagliflozin Side Effects
http://www.invokanahcp.com/safety-information/safety-and-tolerability-profile?utm_source=google&utm_medium=cpc&utm_campaign=Invokana+HCP&utm_term=canagliflozin%20side%20effects&utm_content=Side+Effects+-+Exact|mkwid|suZUJen2m|pcrid|24016786155
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Drug Interactions:1.UGT Inducers (Rifampin, Phenytoin,
Phenobarbitol, Ritonavir)- Decreased canagliflozin, consider increasing dose of canagliflozin
2.Digoxin- Increased digoxin concentration, monitor levels
Pregnancy Category C Do Not Use: GFR <30mL/min, end stage renal
disease, or patients on dialysis
Canagliflozin
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Pre-Marketing Study Results: Average decrease in A1C levels 1%Weight Loss average 5-10 poundsDecrease in systolic blood pressure
approximately 4%Increase HDL approximately 7.6% Increase LDL approximately 11.7%Low risk of hypoglycemia
SGLT-2 Inhibitor-Canagliflozin
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Pipeline:1.Empagliglozin (Eli Lilly/Behringer)2.Dapagliflozin (AstraZeneca)3.Remogliflozin Etabonate (GlaxoSmithKline)4.Sergliflozin Etabonate (GlaxoSmithKline)5.Tofoglitazone (Roche & Chugal)
SGLT-2 Inhibitors
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Medication Average A1C lowering
Hypoglycemic Agent
Weight Gain/Loss
Metformin 1.5% No Loss
Sulfonylureas 1.5% Yes Gain
Glinides 1-1.5% No Gain
SGLT-2 Inhibitors
1% No Loss
TZDs 0.5-1.4% No Gain
α-Glucosidase Inhibitor
0.5-0.8% No Neutral
DPP-4 Inhibitors
0.5-1% No Neutral
Comparing Agents
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Berkrot, Bill. "Johnson & Johnson Diabetes Drug Tops Older Therapies in Studies." Reuters. Thomson Reuters, 09 June 2012. Web. 02 Apr. 2013.
"Canagliflozin Provided Substantial and Sustained Glycemic Improvements as Monotherapy and in Add-On Combinations in Adults with Type 2 Diabetes in Five Phase 3 Studies." Johnson & Johnson. Jansen Research & Development, 09 June 2012. Web. 02 Apr. 2013.
Clarke, Toni. "FDA Approves Johnson & Johnson Diabetes Drug, Canagliflozin." Reuters. Thomson Reuters, 29 Mar. 2013. Web. 01 Apr. 2013.
"Diabetes Treatment, Part 2: Oral Agents for Glycemic Management." Clinical Diabetes. N.p., Oct. 2007. Web. 12 Apr. 2013.
FDA Approves Invokana to Treat Type 2 Diabetes. N.p., n.d. Web. 01 Apr. 2013
"Invokana." INVOKANA™ (Canagliflozin) Treatment for Type 2 Diabetes. N.p., n.d. Web. 12 Apr. 2013
Nainggolan, Lisa. "FDA Approves Canagliflozin, a First-in-Class Diabetes Drug." Medscape Log In. N.p., 29 Mar. 2013. Web. 01 Apr. 2013.
References