Long-Term Clinical Benefits of Canagliflozin 100 mg versus Sulfonylurea in Patients with Type 2 Diabetes Mellitus Inadequately Controlled with Metformin in India.

OBJECTIVES: To simulate the long-term health outcomes of canagliflozin 100 mg versus glimepiride over 20 years in patients with type 2 diabetes mellitus (T2DM) inadequately controlled on metformin from the perspective of the Indian health care system.

METHODS: Health outcomes were simulated using the validated Economic and Health Outcomes Model of T2DM. Patient demographic characteristics, biomarker values, and treatment effects were sourced from a subgroup of Indian patients enrolled in a 52-week, head-to-head study of canagliflozin versus glimepiride (mean maximum dose of 5.6 mg/d) in patients with T2DM inadequately controlled with metformin. Outcomes were discounted at 5%. Sensitivity analyses were conducted using alternative values for key model inputs.

RESULTS: Relative to glimepiride, treatment with canagliflozin 100 mg was associated with approximately 14 more patients surviving at year 20 per 1,000 patients treated and 0.43 quality-adjusted life-years gained, largely because of improved body weight and reduced risk of macrovascular and microvascular morbidity over 20 years. Risk reductions were the largest for microvascular complications (e.g., chronic kidney disease and albuminuria). Improved health outcomes were driven by better glycated hemoglobin control associated with canagliflozin versus glimepiride, which also delayed the need for rescue therapy. Key components of quality-adjusted life-year gains included the avoidance of hypoglycemic episodes, chronic kidney disease, and weight gain, as well as increased survival with canagliflozin compared with glimepiride.

CONCLUSIONS: Simulation results suggest that canagliflozin 100 mg may provide better long-term health outcomes compared with glimepiride in Indian patients with T2DM inadequately controlled with metformin.