Cardiometabolic & kidneyMeta-analysis
Canagliflozin Reduces Oral Loop Diuretic Intensification in Patients with Type 2 Diabetes: A Participant-Level Pooled Analysis of the CANVAS and CREDENCE Trials
- Pooled participant-level analysis of the CANVAS and CREDENCE randomised trials
- CANVAS-R not included
Authors' conclusion
Among high-risk patients with type 2 diabetes, new oral loop diuretic intensification was frequent and portended adverse prognostic significance. Treatment with canagliflozin significantly reduced the need for loop diuretic intensification.
Study context
- Population
- Patients with T2DM at high CV risk or with chronic kidney disease (CKD)1,454 on loop diuretics at baseline
- Participants
- 8,731 patients
- Comparison
- Canagliflozin vs placebo
- Outcome
- Oral loop diuretic intensification (initiation or dose increase)
- Follow-up
- Median on-treatment 2.2 years
Pooled result
Oral loop diuretic intensification · median 2.2 years
Hazard ratio
0.59
95% CI 0.53–0.66
Canagliflozin vs placebo
HR 0.59 (95% CI 0.53–0.66)
As reported in the abstract
Further pooled results
New oral loop diuretic initiation
| Comparison | HR (95% CI) | |
|---|---|---|
| Canagliflozin | 0.65 (0.57–0.74) | |
| 0.512Hazard ratio (log scale) |
Oral loop diuretic dose increase
| Comparison | HR (95% CI) | |
|---|---|---|
| Canagliflozin | 0.42 (0.33–0.54) | |
| 0.20.5125Hazard ratio (log scale) |
Prognosis after oral loop diuretic intensification (vs no intensification)
- Subsequent heart failure (HF) hospitalization, fold higher
- 29.5
- CKD progression, fold higher
- 5.0
- Mortality, fold higher
- 3.5
Expanded HF composite (CV death, HF hospitalization, oral diuretic intensification)
- Approximately double the number of events, with similar observed treatment effect
- HR 0.64; 95% CI 0.58-0.70
Original publication
Canagliflozin Reduces Oral Loop Diuretic Intensification in Patients with Type 2 Diabetes: A Participant-Level Pooled Analysis of the CANVAS and CREDENCE Trials. Eur J Heart Fail. Published 23 January 2025. doi:10.1002/ejhf.3586
Summarised from the published abstract; every number is checked against it