There is a paucity of data evaluating the strategy of intensification of canagliflozin therapy by increasing the dose from canagliflozin 100 mg/d (CANA100) to canagliflozin 300 mg/d (CANA300), since all clinical trials compared both doses separately. The aim of this multicentric study was to assess in real life the effectiveness and tolerability of the intensification of canagliflozin to 300 mg/d in patients with T2DM and suboptimal metabolic control with CANA100. The primary outcome variables were changes in A1c and weight at the end of the follow-up. 317 patients met the inclusion criteria (age 62.2 years, A1c 7.55%, weight 88.6 kg). Median time of treatment with CANA300 was 20.8 months. Switching to CANA300 induced a significant decrease in A1c (-0.47%) and weight (-2.9 kg), both p<0.0001. The percentage of patients with A1c <7% increased significantly from 26.7% with CANA100 to 51.6% with CANA300 (p<0.0001). In those individuals with poor glycemic control (A1c >8%, mean 9.0%), A1c was significantly reduced by -1.24% (p<0.0001). There were significant improvements in FPG (-14.8 mg/dl), SBP (-5.3 mmHg) and DBP (-3,1 mmHg), all p<0.05. Serum liver enzymes and albuminuria also decreased significantly. Considering the entire treatment period (initial treatment with CANA100 and later switch to CANA300), with a median follow-up of 38.8 months, patients achieved a statistically significant overall reduction in A1c (-1.30%), weight (-5.8 kg), SBP (-9.6 mmHg) and DBP (-4.7 mmHg), all p<0.0001. 7.9% of patients discontinued CANA300; the most frequent causes of withdrawals were genital mycotic infections (1.9%) and urinary tract infections (0.9%).

In summary, intensification of canagliflozin therapy to CANA300 achieved further significant and clinically relevant reductions in A1c, weight, and BP in patients with T2DM. The effectiveness of the switch was particularly relevant in those patients with higher A1c levels.


J.J. Gorgojo-Martinez: Advisory Panel; AstraZeneca, Bayer Inc., Novo Nordisk. Research Support; Eli Lilly and Company, Mundipharma, Novo Nordisk. Speaker's Bureau; AstraZeneca, Boehringer Ingelheim Inc., Eli Lilly and Company, Mundipharma, Novo Nordisk, Amarin Corporation. P.J. Ferreira-Ocampo: None. A. Galdon-Sanz Pastor: None. J.J. Cárdenas-Salas: Speaker's Bureau; Novo Nordisk, Mundipharma, Lilly, AstraZeneca. Other Relationship; Mylan, Amgen Inc., Almirall, S.A. T. Antón-Bravo: Speaker's Bureau; Abbott Nutrition, AstraZeneca, Eli Lilly and Company. Advisory Panel; Fresenius Kabi. Speaker's Bureau; Novo Nordisk, Daiichi Sankyo. Advisory Panel; Sanofi. Other Relationship; Mundipharma. M. Brito: Speaker's Bureau; AstraZeneca, Eli Lilly and Company, Mundipharma, Novo Nordisk, Sanofi. Advisory Panel; Sanofi. Speaker's Bureau; Almirall, S.A., Boehringer-Ingelheim, Esteve. Advisory Panel; Esteve, AstraZeneca. Research Support; Mundipharma. F. Almodovar-Ruiz: None.


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