Dual-Drug Type 2 Diabetes Treatment Cleared by FDA

Aug 8, 2014 — Janssen Pharmaceuticals, Inc, announced the FDA has approved Invokamet, a fixed-dose therapy combining canagliflozin and metformin hydrochloride in a single tablet, for the treatment of adults with type 2 diabetes.

Invokamet provides the clinical attributes of canagliflozin (Invokana), the first sodium glucose co-transporter 2 (SGLT2) inhibitor available in the United States, together with metformin, which is commonly prescribed early in the treatment of type 2 diabetes. Invokamet is the first fixed-dose combination of an SGLT2 inhibitor with metformin approved in the United States.

"Invokamet combines, in 1 tablet, 2 complementary therapeutic approaches proven effective for managing type 2 diabetes," said Richard Aguilar, MD, Medical Director of Diabetes Nation. "Canagliflozin works with the kidney to promote the loss of glucose in the urine, whereas metformin decreases the production of glucose in the liver and improves the body's response to insulin."

Invokamet is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus who are not adequately controlled by treatment that includes either canagliflozin or metformin, or who are already being treated with both canagliflozin and metformin as separate medications. Invokamet should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. Study results demonstrated that administration of Invokamet was equivalent to co-administration of corresponding doses of canagliflozin and metformin as individual tablets.

Invokamet will be available in tablets containing canagliflozin 50 mg or 150 mg, and metformin 500 mg or 1000 mg. The recommended dosing is twice daily. The prescribing information for Invokamet also contains a boxed warning for lactic acidosis, a rare, but serious complication that can occur due to metformin accumulation.

"Invokamet provides adults with type 2 diabetes an oral therapy that lowers blood sugar and is also associated with reductions in body weight and systolic blood pressure," said Jimmy Ren, PhD, Therapeutic Area Lead, Metabolics, Medical Affairs, Janssen Pharmaceuticals, Inc. "The available doses of Invokamet allow physicians to tailor therapy for individual patient needs and offer an alternative for patients who may be able to reduce the number of tablets they take each day."

The co-administration of canagliflozin and metformin has been studied in 6 Phase 3 clinical studies that enrolled 4732 patients with type 2 diabetes. The studies evaluated canagliflozin in combination with metformin compared to metformin alone or to metformin plus another diabetes therapy. The trials showed that the combination of canagliflozin and metformin lowered blood sugar and, in pre-specified secondary endpoints, was associated with significant reductions in body weight and systolic blood pressure.

In 2 studies comparing canagliflozin plus metformin to current standard treatments plus metformin—1 studying sitagliptin and the other studying glimepiride–canagliflozin dosed at 300 mg provided greater reductions in A1C levels and body weight than either comparator. In the studies, the overall incidence of adverse events was similar with canagliflozin and the comparators.

Results from the Phase 3 studies showed that the most common adverse events with canagliflozin are female genital mycotic (fungal) infections, urinary tract infections, and increased urination. These specific adverse events were generally mild to moderate in intensity and infrequently led to discontinuation in Phase 3 studies.

The most common adverse reactions due to initiation of metformin, as noted in the prescribing information for that medication, are diarrhea, nausea/vomiting, flatulence, asthenia, indigestion, abdominal discomfort, and headache. Hypoglycemia does not occur in patients receiving metformin alone under usual circumstances of use. Canagliflozin can increase the risk of hypoglycemia when combined with insulin or a medication that increases insulin levels, such as a sulfonylurea. Therefore, a lower dose of insulin or insulin-raising medication may be required to minimize the risk of hypoglycemia when used in combination with Invokamet.