Treatment With Canagliflozin Versus Placebo in Children and Adolescents With Type 2 Diabetes : A Randomized Clinical Trial.

Abstract

Treatment options for children and adolescents with type 2 diabetes mellitus (T2DM) are limited. Canagliflozin is a sodium-glucose cotransporter-2 inhibitor approved for the treatment of T2DM in adults. To assess the safety and efficacy of canagliflozin in children and adolescents with T2DM. Phase 3, randomized, double-blind, placebo-controlled, parallel-group study. (ClinicalTrials.gov: NCT03170518; EudraCT: 2016-005223-88). Multicenter (104 sites in 10 countries). Children and adolescents aged 10 years or older with T2DM (hemoglobin A_1c [HbA_1c] ≥6.5% to ≤11%). Participants were randomly assigned to canagliflozin (100 mg) or placebo once daily. Participants with week 12 readings of 7% or higher for HbA_1c and at least 60 mL/min/1.73 m² for estimated glomerular filtration rate were randomly assigned again at week 13 to either keep receiving 100 mg of canagliflozin (or placebo) or have their dose uptitrated to 300 mg (or placebo). The treatment period was 52 weeks. Change in HbA_1c from baseline to week 26 (primary efficacy end point), secondary efficacy end points, and safety. A total of 171 participants were randomly assigned to canagliflozin (<i>n</i> = 84) or placebo (<i>n</i> = 87). At week 26, HbA_1c reduction from baseline was significantly greater with canagliflozin than placebo (difference in least-squares means, -0.76% [95% CI, -1.25% to -0.27%]; <i>P</i> = 0.002). The proportion of participants who achieved HbA_1c levels below 6.5% was significantly greater with canagliflozin than placebo (36.3% vs. 14.0%; difference, 22.3 percentage points [CI, 10.5 to 34.1 percentage points]). Treatment-emergent adverse events (AEs) occurred in 77.4% and 74.7% and serious treatment-emergent AEs in 9.5% and 5.7% of participants who received canagliflozin and placebo, respectively. Common AEs seen with canagliflozin were similar to those in the adult population. Hypoglycemia occurred in 11.9% and 10.3% of participants receiving canagliflozin and placebo, respectively. Study duration and relatively small sample size. In children and adolescents with T2DM, canagliflozin provided a clinically meaningful reduction in HbA_1c, with a safety profile similar to that seen in adults. Johnson & Johnson.