1206-P: Effects of Canagliflozin (CANA) on Initiation of Insulin in CANVAS Program
Authors: MATTHEWS DAVID R. , WYSHAM CAROL H. , DAVIES MELANIE J. , SLEE APRIL , ALBA MARIA , LEE MARY , CAPUANO GEORGE , PERKOVIC VLADO , MAHAFFEY KENNETH W. , NEAL BRUCE 
Published: June 2019

The impact of CANA treatment on the initiation of insulin and other antihyperglycemic agents (AHAs) was analyzed in the CANVAS Program, which randomly assigned 10,142 participants with type 2 diabetes and established cardiovascular (CV) disease or ≥2 CV risk factors to treatment with CANA or placebo (PBO). Fewer participants initiated new AHAs with CANA versus PBO (17.8% vs. 27.0%; P &lt;0.0001). Among those not on insulin at baseline, fewer participants initiated insulin with CANA versus PBO (9.3% vs. 17.8%). The time to initiation of insulin was delayed with CANA versus PBO (Figure). The risk of initiating insulin was 2.6 times lower for participants treated with CANA compared with PBO (hazard ratio [HR] 0.39 [95% CI: 0.33, 0.46]; P &lt;0.0001). At 312 weeks (6 years), 17.9% and 33.0% of participants treated with CANA and PBO, respectively, had initiated insulin. Delay in insulin initiation was also seen with CANA versus PBO in subgroups by baseline estimated glomerular filtration rate (eGFR); patients with eGFR ≥60 and &lt;60 mL/min/1.73 m2 had a 2.7 and 1.9 times lower risk of insulin initiation with CANA versus PBO, respectively. In the CANVAS Program, participants treated with CANA initiated fewer AHAs and had longer time to the initiation of insulin compared with participants treated with PBO. The delay in initiation of insulin with CANA may represent reduced utilization of health services and a benefit to patients.

Disclosure
D.R. Matthews: Advisory Panel; Self; Janssen Research & Development, Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Sanofi, Servier. Consultant; Self; Janssen Research & Development, Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Servier. Research Support; Self; Janssen Research & Development. Speaker's Bureau; Self; Ach&#x00E9; Laboratories, Janssen Research & Development, Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Sanofi, Servier. C.H. Wysham: Advisory Panel; Self; Abbott Laboratories. Board Member; Self; Endocrine Society. Consultant; Self; Lexicon Pharmaceuticals, Inc. Research Support; Self; Mylan. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Dexcom, Inc. Other Relationship; Self; Janssen Pharmaceuticals, Inc., Novo Nordisk A/S, Sanofi. M.J. Davies: Advisory Panel; Self; Eli Lilly and Company, Janssen Global Services, LLC., Novo Nordisk A/S, Sanofi-Aventis, Servier. Research Support; Self; Boehringer Ingelheim International GmbH, Novo Nordisk Foundation. Speaker's Bureau; Self; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk A/S, Sanofi-Aventis, Takeda Pharmaceutical Company Limited. A. Slee: None. M. Alba: Employee; Self; Janssen Research & Development. M. Lee: Employee; Self; Janssen Research & Development. G. Capuano: Employee; Self; Janssen Research & Development. V. Perkovic: Advisory Panel; Self; AbbVie Inc., Astellas Pharma Inc., AstraZeneca, Baxter, Bayer US, Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb Company, Durect Corporation, Eli Lilly and Company, Gilead Sciences, Inc., GlaxoSmithKline plc., Janssen Research & Development, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Pfizer Inc., Pharmalink, Relypsa, Inc., Roche Pharma, Sanofi, Servier, Vitae. Research Support; Self; Australian National Health and Medical Research Council. Other Relationship; Self; AbbVie Inc., Boehringer Ingelheim Pharmaceuticals, Inc., GlaxoSmithKline plc., Janssen Research & Development, Pfizer Inc. K.W. Mahaffey: Consultant; Self; Abbott, Ablynx, Baim Institute, Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb Company, Cardiometabolic Health Congress, Elsevier, GlaxoSmithKline plc., Medergy, Medscape, Mitsubishi Tanabe Pharma Corporation, MyoKardia, Inc., Novo Nordisk Inc., Ocleuve, Portola Pharmaceuticals, Inc., Radiometer America, Springer Publishing, Theravance, UCSF. Research Support; Self; Afferent, Amgen Inc., Apple, Cardiva Medical, Inc, Daiichi, Ferring Pharmaceuticals, Google, Luitpold Pharmaceuticals, Inc., Medtronic, Sanofi, St.Jude, Tenax. Stock/Shareholder; Self; BioPrint Fitness. Other Relationship; Self; AstraZeneca, Johnson & Johnson, Merck & Co., Inc., National Institutes of Health, Novartis Pharmaceuticals Corporation. B. Neal: Advisory Panel; Self; Janssen Research & Development, Novartis Pharmaceuticals Corporation, Pfizer Inc., Roche Pharma, Servier. Research Support; Self; Abbott, Australian National Health and Medical Research Council, Janssen Research & Development, Merck & Co., Inc., Roche Pharma, Servier.

Funding
Janssen Research & Development, LLC