Efficacy and safety of replacing sitagliptin with canagliflozin in real-world patients with type 2 diabetes uncontrolled with sitagliptin combined with metformin and/or gliclazide: The SITA-CANA Switch Study

Aim. - To analyze the efficacy and safety of replacing sitagliptin with canagliflozin in patients with type 2 diabetes (T2D) and poor metabolic control despite treatment with sitagliptin in combination with metformin and/or gliclazide. Materials and methods. - In this multicentre observational, retrospective, 26-week clinical study of patients with T2D and poor glycaemic control (HbA1c: 7.5-9.5%) treated with sitagliptin in combination with metformin and/or gliclazide, sitagliptin (and gliclazide if appropriate) were replaced by canagliflozin. The main outcome of the study was the proportion of patients who achieved good glycaemic control (HbA1c < 7%) by the end of the study. Results. - The study sample comprised 50 patients (baseline HbA1c 8.0 +/- 0.6%) treated with sitagliptin 100 mg/day, 14 of whom were also taking gliclazide 60 mg/day while 38 were taking metformin 1700 mg/day. Sitagliptin treatment was replaced by either canagliflozin 100 mg (n = 17) or 300 mg (n = 33). After 26 weeks of follow-up, these patients presented with significant decreases in HbA1c (-1.1%; P < 0.000), weight (-3.89 kg; P < 0.000), BMI (-1.37 kg/m(2); P < 0.022), abdominal circumference (-5.42 cm; P < 0.004), systolic and diastolic blood pressure (-5.3 mmHg and -4.4 mmHg, respectively; P = 0.005), triglycerides (-42 mg/dL; P = 0.005) and LDL/HDL cholesterol ratio (-0.34; P = 0.005). By the end of the study, 42% of patients had achieved HbAlc levels < 7%. Conclusion. - In patients with T2D poorly controlled with sitagliptin, whether alone or in combination with metformin and/or gliclazide, replacing it with canagliflozin may be a simple yet effective intensification strategy. Our results, which may have important implications for clinical practice, now need to be confirmed in larger observational studies. (C) 2018 Elsevier Masson SAS. All rights reserved.