Canagliflozin (Invokana). A "me-too" of the dangerous dapagliflozin.

Currently, metformin is the only oral hypoglycaemic drug with reasonably well-established efficacy in preventing the complications of type 2 diabetes. Canagliflozin is the second renal sodium-glucose cotransporter 2 (SGLT2) inhibitor to be authorised in the European Union, after dapagliflozin. Initial evaluation of canagliflozin included no controlled clinical trials designed to determine its efficacy in preventing the clinical complications of diabetes. The eight available placebo-controlled trials show a moderate hypoglycaemic effect (mean HbA1c decline: -0.7%), similar to that of dapagliflozin. This effect is reduced in patients with renal failure. Canagliflozin has the same adverse effects as dapagliflozin, due to their shared mechanism of action: they include urogenital infections, arterial hypotension, dehydration, and altered renal function. As with dapagliflozin, questions remain as to the long-term risk of fractures and malignancies. A risk of cardiovascular toxicity in some patients cannot be ruled out. In practice, canagliflozin and dapagliflozin share many properties, particularly an unfavourable harm-benefit balance, and neither drug should be used.