Abstract: FR-OR08
Cardiovascular, Kidney, and Safety Outcomes with Canagliflozin in Older Adults: A Pooled Secondary Analysis of the CANVAS Program and CREDENCE Trial
Session Information
- CKD: Care Patterns and Novel Therapeutic Approaches
October 25, 2024 | Location: Room 25, Convention Center
Abstract Time: 05:40 PM - 05:50 PM
Category: Geriatric Nephrology
- 1300 Geriatric Nephrology
Authors
- Siriwardana, Amanda, The University of Sydney School of Medicine, Sydney, New South Wales, Australia
- Jardine, Meg, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
- Perkovic, Vlado, The George Institute for Global Health, Sydney, New South Wales, Australia
- Jun, Min, The George Institute for Global Health, Sydney, New South Wales, Australia
- Kotwal, Sradha S., The George Institute for Global Health, Sydney, New South Wales, Australia
- Arnott, Clare Gabrielle, The George Institute for Global Health, Sydney, New South Wales, Australia
- Neuen, Brendon Lange, The George Institute for Global Health, Sydney, New South Wales, Australia
Background
Sodium glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of cardiovascular and kidney outcomes in patients with type 2 diabetes (T2DM). With the growing prevalence of T2DM among older adults, it is important to understand whether the efficacy and safety of SGLT2 inhibitors differs in older individuals.
Methods
In this post hoc analysis, individual participant data from the CANVAS Program (n=10,142) and CREDENCE trial (n=4401) were pooled and analysed according to baseline age (<65 years, 65 to <75 years, and ≥75 years). Outcomes of interest were: major adverse cardiovascular events (MACE, defined as nonfatal myocardial infarction, nonfatal stroke or cardiovascular death), hospitalisation for heart failure or cardiovascular death, CKD progression (defined as doubling of serum creatinine, kidney failure or death due to kidney failure), and safety outcomes. Hazard ratios and 95% confidence intervals were estimated using Cox proportional hazards models, stratified by age group.
Results
Among the 14,543 participants, 7,927 (54.5%) were <65 years, 5,281 (36.3%) were 65 to <75 years, and 1,335 (9.2%) were ≥75 years. Older participants had higher rates of hypertension and heart failure, longer diabetes duration, lower mean eGFR and lower median urine albumin:creatinine ratio. Across age groups, consistent relative risk reductions were observed with canagliflozin for MACE, hospitalisation for heart failure or cardiovascular death, and for CKD progression (all P trend > 0.10, Figure 1 Panel A). Similarly, the effects of canagliflozin on serious adverse events, acute kidney injury, and serious hypoglycaemia, were consistent across age categories (all P trend >0.10; Figure 1 Panel B).
Conclusion
In this pooled CANVAS and CREDENCE analysis of T2DM patients with varying degrees of kidney impairment, canagliflozin demonstrated consistent benefits across the spectrum of age for cardiovascular and kidney outcomes, with no additional safety concerns identified.