Learning More about New Drugs

Inside the front covers of both the June 3, 2014 issue of The Annals of Internal Medicine and the June 12, 2014 issue of The New England Journal of Medicine you can find the same advertisement for Farxiga (dapagliflozin) telling you that it is now approved, that it comes in 5-mg tablets, and that you can ”Learn more at farxiga-info.com.” You could go to that web site and you would find out that Farxiga is a new drug for type 2 diabetes and that the manufacturer is enthusiastic about it.

Or you could go to www.medicalletter.org and learn much more. We reviewed dapagliflozin for the first time in the February 17, 2014 issue of The Medical Letter. A table on the first page of our review would immediately let you know that dapagliflozin (Farxiga) is the second of 2 SGLT2 inhibitors marketed in the US, that canagliflozin (Invokana) is the other one, that both are taken once a day, and that their prices are nearly identical. The interesting mechanism of action of SGLT2 (sodium-glucose co-transporter 2) inhibitors is explained briefly, but clearly, in the text: they decrease renal glucose reabsorption and increase urinary glucose excretion, resulting in a reduction in blood glucose levels. Another table summarizes the available clinical studies of dapaglozin. And our conclusion tells you that dapagliflozin, like canagliflozin, is modestly effective in reducing HbA1C, but both can cause genital mycotic infections, and their long-term safety is unknown.

If you wanted to know more about where these 2 drugs fit into the treatment of type 2 diabetes, and what the alternatives are, you could go to our March 1, 2014 article in Treatment Guidelines from The Medical Letter on Drugs for Type 2 Diabetes. There you would immediately see in the Recommendations paragraph at the top of the first page that SGLT2 inhibitors are not recommended for first-line or even second-line use. A large table on one of the following pages lists the A1C reductions, advantages, and adverse effects of all the oral drugs for type 2 diabetes, and you can see for yourself the basis for the recommendations.

Or you could follow the advice in the advertisement and see what the manufacturer has to say about Farxiga. The choice is yours.

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  1. Dacso, Clifford C says:

    This is why I am a 40 year subscriber to TML!

    Clifford C. Dacso, MD, MPH, MBA Professor, Molecular & Cell Biology and Medicine Baylor College of Medicine Hugh Roy and Lillie Cranz Cullen Professor University of Houston College of Technology Adj. Prof. Electrical and Computer Engineering Rice University

    From: “More@MedLetter” <comment-reply@wordpress.com> Reply-To: “More@MedLetter” <comment+rixqohg_8d7_36r14skwlj5@comment.wordpress.com> Date: Thursday, June 19, 2014 at 8:47 AM To: Clifford Dacso <cdacso@bcm.edu> Subject: [New post] Learning More about New Drugs

    Mark Abramowicz, M.D. posted: “Inside the front covers of both the June 3, 2014 issue of The Annals of Internal Medicine and the June 12, 2014 issue of The New England Journal of Medicine you can find the same advertisement for Farxiga (dapagliflozin) telling you that it is now approve”

  2. In controlled trials, the 300 mg per day dose of Invokana (canagliflozin) was associated with an average increase in LDL cholesterol of 8.3 mg/dL, which is usually dismissed as “minor”. However, based on prior data, we can expect one additional death for every 52 diabetic patients treated with 300 mg/day of canagliflozin per day for 4.3 years, plus for every 22 diabetic patients treated with canagliflozin over 4.3 years, one additional major vascular event would be expected on the basis of the associated increase in LDL cholesterol (1). Does this worry anyone besides me?

    1: Keller DL. Canagliflozin. Cleve Clin J Med. 2014 Feb;81(2):88-90. doi:
    10.3949/ccjm.81c.02004. PubMed PMID: 24493489.

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