Power Point - New Mexico Pharmacists Association

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Transcript Power Point - New Mexico Pharmacists Association

The Diabetes
Download: Diabetes
Update 2017
KIM NEFF, PHARMD, PHC
CLINICAL PHARMACY SPECIALIST, AMBULATORY CARE
NEW MEXICO VA HEALTHCARE SYSTEM
Objectives


Pharmacist Objectives:

Explain the 2016 FDA safety alerts and labeling changes for diabetes
medications

Counsel patients on diabetic medications incorporating the information
from the FDA safety alerts

Describe the 2017 updates to the American Diabetes Association standards
of care in diabetes
Technician Objectives

Identify medications affected by recent FDA safety alerts

Describe the 2016 safety alerts and labeling changes for diabetes
medications

Describe the 2017 updates to the American Diabetes Association standards
of care in diabetes
https://www.pinterest.com/kascott29/rx/
Safety Studies for Diabetes
Medications

FDA change in 2008 regarding expectation of drug studies for new
diabetic medications to ensure there is no unacceptable
cardiovascular risk1

Prompted by1-2

Recommendations of the 2008 Endocrinologic and Metabolic Drugs
Advisory Committee

High cardiovascular risk in patients with diabetes

Safety issues with

Rosiglitazone

Muraglitizar

Intense glucose lowering in the ACCORD trial
Safety Studies for Diabetes
Medications

FDA expectations1

Independent cardiovascular endpoints committee

Evaluation of

Cardiovascular mortality

Stroke

Myocardial infarction

Design studies so can be easily and clearly analyzed via a meta-analysis at study
completion

Should include patients with high cardiovascular risk


Elderly

Renal impairment

Advanced cardiovascular disease
Pre and post-marketing trials may be required for new drugs depending upon
estimated risk of pre-marketing studies
DPP4 Inhibitors
FDA 1st
safety
communic
ation about
saxagliptin
and heart
failure
Sitagliptin
2006
2005
Saxagliptin
2009
Linagliptin
2011
2011
And then
this year…
Alogliptin
2013
2017
DPP4 Inhibitors and Heart failure
4/5/2016
“FDA Drug Safety communication: FDA adds warnings about heart
failure risk to labels of type 2 diabetes medicines containing saxagliptin
and alogliptin”3
Safety trials for DPP4 Inhibitors
Study
Name
SAVOR-TIMI
534
EXAMINE5-6
TECOS7
# of
patients
16, 492
5,380
14,671
Study drug
vs placebo
Saxagliptin
Alogliptin
Sitagliptin
A1C
Range
(%)
6.5 - 12
6.5 - 11
6.5 - 8
Primary
Outcome
(DPP4 vs
placebo)
Noninferior
Noninferior
Noninferior
Hospitalization P value
due to heart
failure (DPP4 vs
placebo)
289 (3.5%) vs
223 (2.8%)
106 (3.9%) vs
89 (3.3%)
228 (3.1%) vs
229 (3.1%)
Comments/other
results
0.007
Higher risk HF in
history of HF, renal
impairment
0.22
Significant higher
risk of hospitalization
due to heart failure
in patients without
previous history of
HF (P = 0.026)
0.98
Excluded patients
with eGFR <3 0
ml/min per 1.73m2
DPP4 Inhibitors and Heart failure:
Retrospective Study8

Evaluated new users of

Saxagliptin

Sitagliptin

Second generation sulfonylureas

Pioglitazone

Long acting insulin

Follow up time <1 year

No overall increase in incidence of hospitalization due to HF in new
users of saxagliptin and sitagliptin compared to pioglitazone,
sulfonylureas, or long acting insulin
DPP4 Inhibitors and Heart failure:
Retrospective Study8
DPP4 Inhibitors and Heart failure:
Retrospective Study8


Recommend cautious interpretation

Retrospective study design

Short follow up time
Re-enforces lack of association of sitagliptin with heart failure
BUT, 2/3 cohort studies found a positive association of sitagliptin with
heart failure9-11
And…
Results from the FDA Adverse Event
Reporting System (FAERS)12
Results from the FDA Adverse Event
Reporting System (FAERS)12
What About Linagliptin?


Two large trials ongoing, results not out
yet

CARMELINA– cardiovascular

CAROLINA—cardiovascular and renal
outcomes
Pooled study of 19 study results and
ADEs13

Increased heart failure incidence but not
clear if significant

Must interpret w/caution since pooled
data
DPP4 Inhibitors and Heart Failure:
Clinical Considerations

Conflicting evidence regarding HF risk

Avoid DPP4I if has HF and other treatment options available

If to use DPP4I, sitagliptin likely safest option

Careful w/renal impairment

Still may have some HF risk

May consider alternate option even if any risk factors for HF

Do not recommend with very poor blood sugar control

Low level of A1C lowering

Possibility that poorer control may be more associated with higher HF risk
Counseling on DPP4 Inhibitors

Possibility of heart failure

Patients need to contact their provider right away if:

Difficulty breathing w/laying down

Edema/swelling in ankles, feet, legs, stomach

Unusual SOB

Dyspnea on exertion

If on a renally adjusted dose, HF education may be more important

Other possible ADEs to educate on

Arthralgias

Pancreatitis

hypoglycemia
The New Kids on the Block
http://images4.fanpop.com/image/photos/22100000/nkotb-new-kids-on-the-block-22146585-1152-1156.jpg
http://www.mims.co.uk/sglt2-inhibitors-risk-diabetic-ketoacidosis/diabetes/article/1353980
Empagliflozin and CV Protection

12/2/2016

Jardiance® (Empagliflozin) gains new FDA approval14


To reduce cardiac death in patients with type 2 DM
Approval based on EMPA-REG study15

Significant improvement in various cardiovascular endpoints

Composite cardiovascular outcome

Death from cardiovascular causes

Non-fatal MI*

Non-fatal stroke*

Death from any cause

Hospitalization from heart failure
* defines not independently significant difference
EMPA-REG Study
15
Results
EMPA-REG Study
15
Results
Empagliflozin and CV

15
Protection
CV benefit thought to be due to mechanisms other than just A1C
lowering

Changes in arterial stiffness, cardiac function and cardiac oxygen
demand

Cardiorenal effects

Reduction in


Albuminuria

uric acid

Weight

visceral adiposity

Blood pressure
Improved blood sugar
Empagliflozin and CV

15
Protection
Significant safety outcomes


Less than placebo

UTI in women than placebo

Acute renal failure

Acute kidney injury

ADEs leading to study discontinuation
More than placebo

Genital infections in both men and women

Non-significant but more urosepsis
Empagliflozin For Everyone?
https://koshersamurai.files.wordpress.com/2012/12/monopoly-man-rich-guy.jpg
http://www.multivu.com/players/English/7617351-bi-lilly-empa-reg-cv-results/
Moving Forward with Empagliflozin


CV benefit impressive

Prevents death in 1 in 45 patients over 3 years16

Prevents overall mortality in 1 in 39 patients16
Points to keep in mind

Benefit was shown in patients

with cardiovascular disease

In addition to optimal treatment

Patients without cardiovascular disease were not a part of the study

No significant reduction in stroke or heart attack

Empagliflozin isn’t cheap

Although less than other SGLT2s, empagliflozin has side effects
Canagliflozin and Amputations

5/18/2016

FDA warns of increase risk of leg and foot amputations, mostly
affecting the toes, with the diabetes medicine canaglfilozin17

Canagliflozin Cardiovascular Assessment Study (CANVAS)

Investigating cardiovascular safety

Interim analysis showed higher risk of amputation (particularly toe) in
canagliflozin than placebo17


7/1000 with canagliflozin 100mg daily

5/1000 with canagliflozin 300mg daily

3/1000 with placebo daily
Study was permitted to continue
Canagliflozin and Amputations

European Medicine’s Agency (EMA) has also started to review
canagliflozin after this interim result from CANVAS18

CANVAS R trial (A study of the effects of canagliflozin on renal
endpoints in adult participants with type 2 diabetes mellitus)


Hasn’t shown same results17

Non-statistically significant difference between canagliflozin and
placebo for amputations19

16 amputations in canagliflozin group, 12 in placebo

Estimated incidence 7/1000 compared to 5/1000
Inagaki et al20

Didn’t show increased amputation risk
Canagliflozin and Amputations

Mechanism– not clear

Dehydration?

Volume depletion?
Application to Clinical Practice

Noteworthy possible risk but shouldn’t significantly affect prescribing

Avoid and/or discontinue in patient with lower limb complications

Closely monitor patients with risk factors for amputation


Peripheral vascular disease

Neuropathy

Previous amputations
Education on preventative foot care and good hydration important
SGLT2 and Renal Impairment
6/14/2016
“FDA strengthens kidney warnings for diabetes medicines canagliflozin
(Invokana®, Invokamet®) and dapagliflozin (Farxiga®, Xigduo XR®)”21
Prompted by case reports after drug approval
Canagliflozin/Dapagliflozin and
Renal Impairment21

Oct 2014-sept 2015, ~1.5 million got prescription for dapagliflozin or
canagliflozin

In 2.5 years (March 2013-Oct 2015), 101 confirmed cases of acute
kidney injury (AKI) with dapagliflozin or canagliflozin use

96 required hospitalization

22 admitted to intensive care units

4 deaths (2 cardiac-related)

15 patients received dialysis


3 had underlying CKD

6 were also on ACEI and diuretic
~50% happened within 1 month of drug start
Canagliflozin/Dapagliflozin and
Renal Impairment21

Patient characteristics

28-79 yo, median age 57

Over 50% <60 yo

51 on ACEI

26 diuretic

6 NSAID

10 previous CKD
Canagliflozin/Dapagliflozin and
Renal Impairment21


Change in renal function

Median reported increase of SCr = 1.5mg/dL

Median decrease in eGFR 46 ml/in/1.73m2
Most cases reversible but not all (76 reported discontinuation)

56 reported improvement

11 didn’t improve (including 4 deaths)

3 recovered with sequela
Canagliflozin and Renal

22
Effects
Generally a drop in GFR in the first 3-6 weeks of canagliflozin
initiation ~2-6mL/min/1.73m2 across studies

Trends of eGFR similar across most subsets

Degree of eGFR slightly higher in elderly and worsened renal function
but clinical significance questionable

Most eGFR drops stabilize or are attenuated by 26-104 weeks

>30% reductions in eGFR more common in CKD patients with
canagliflozin vs placebo

Canagliflozin 100mg - 31/332 (9.3%)

Canagliflozin 300mg - 43/352 (12.2%)

Placebo - 18/367 (4.9%)
Canagliflozin and Renal

>50% reduction not significantly different across groups with normal
renal function and moderate renal impairment (all less than 1%)



22
Effects
Normal renal impairment

Canagliflozin 100mg - none

Canagliflozin 300mg - 1/805 (0.1%)

Placebo- 1/624 (0.2%)
Stage 3 CKD pts: canagliflozin1.5% w/>50% drop in SCr, 0.9% of 300, none for
placebo

Canagliflozin 100mg – 5/332 (1.5%)

Canagliflozin 300mg – 3/352 (0.9%)

Placebo- none
In all cases, fewer patients had significant reductions at last postbaseline assessment
Canagliflozin and
22
eGFR
Dapagliflozin and
23
eGFR
Decrease in eGFR Generally
Reversible22
Intern tells you he learned in class
SGLT2s may be renal protective…
BAD?
OR
GOOD?
http://www.ebay.com/itm/DARTH-VADER-STAR-WARS-LIFESIZE-CARDBOARD-STANDUP-STANDEE-CUTOUT-POSTER-FIGURE-/271239202903
https://en.wikipedia.org/wiki/Yoda Accessed 12/3/2016
SGLT2 effect on the
22
Kidney
Empagliflozin and Renal Protection

EMPA-REG OUTCOME trial24

Empagliflozin showed renal protection

Less incident nephropathy (12.7 % vs 18.8%, P < 0.001)

Most independent components significantly less in empagliflozin group as
well (shown as empagliflozin vs placebo)

Progression to macroalbuminuria (11.2% vs 16.2%), RRR 38%

Doubling of serum creatinine (1.5 vs 2.6%) RRR 44%

Progression to renal replacement therapy (0.3% vs 0.6%) rrr 55%

Benefits seen across pre-specified subgroups and both doses

Less acute renal failure in empagliflozin than placebo
EMPAREG and Renal
24
Outcomes
EMPAREG and Renal
24
Outcomes
EMPAREG and Renal
24
Outcomes
Good or Bad?
Empagliflozin
http://www.ebay.com/itm/DARTH-VADER-STAR-WARS-LIFESIZE-CARDBOARD-STANDUP-STANDEE-CUTOUT-POSTER-FIGURE-/271239202903
https://en.wikipedia.org/wiki/Yoda Accessed 12/3/2016
Other SGLT2s and Albuminuria

Some studies have shown reductions in albumin to creatinine ratios
with canagliflozin25-28


Most favored improvement in albuminuria but not statistically significant
Kohan et al23 showed dapagliflozin more likely to regress to a lower
albumin excretion category
SGLT2 and Renal Impairment

Concern for risk of acute renal impairment

Canagliflozin

Dapagliflozin
Important time for monitoring is in the first 4-6 weeks
 Use caution in:


HF

Poor hydration status

Fluid loss

Acute GI illness

ACE, ARB, NSAIDs, and diuretics

Other meds which can potentially cause renal impairment

Normotensive patients
SGLT2 and Renal Impairment

Renal impairment is often reversible

Empagliflozin provides long term renal protection

May be some new data when CANVAS R study is completed

SGLT2 not recommended in patients with impaired renal function



Dapagliflozin:

Do not initiate therapy with eGFR less than 60 mL/min/1.73 m2

Not recommended if eGFR is persistently between 30 and 60 mL/min/1.73 m2
Empagliflozin

Do not initiate therapy with eGFR less than 45 mL/min/1.73 m2

Discontinue if eGFR is persists below 45 mL/min/1.73 m2
Canagliflozin

Do not exceed 100mg orally once daily if eGFR is 45 to 60 mL/min/1.73 m2

Do not initiate therapy with eGFR less than 45 mL/min/1.73 m 2

Discontinue if eGFR is persists below 45 mL/min/1.73 m2
SGLT2 Counseling




Preventative foot care

monitoring for cuts/scrapes

Seek attention right away if any open wounds, discoloration, or new
onset pain or tenderness
Importance of good hydration

Seek attention if s/sx of water or salt loss

Use caution w/diuretics, HF
Signs of renal impairment

Decreased urine production

Swelling in legs or feet
Importance of lab follow up
SGLT2 Counseling

Risk of genital infection/UTI, corresponding symptoms

Risk of hypotension



Seek attention if develops dizziness

Recommend blood pressure monitoring while on tx
DKA

Counsel on symptoms and risk

Highly importance of seeking IMMEDIATE attention if has symptoms
Highlight for empagliflozin only

CV benefit in patients with CV disease

Renal protection
Metformin and Renal Dosing

Previous labeling:

Contraindicated

Men with SCr >1.5mg/dL

Women with SCr >1.4mg/dL

Intended to prevent use in patients with any type of renal impairment
for safety

Main concern was lactic acidosis risk
Metformin and Renal Dosing

4/8/2016

FDA determined after evaluating the current evidence29


eGFR should be used for determination of renal function

Safe use of metformin in mild renal impairment

Labeling modified
New guidance has been used prior to FDA label change30
FDA Changes to Metformin
Labeling29
Before starting, check creatinine/determine eGFR
 Check eGFR



At least annually

More often in high risk populations
Iodinated contrast imaging

Stop prior in below patients

eGFR 30-60 mL/minute/1.73 m2

Liver disease

Alcoholism

Heart failure

Re-check eGFR 48 hours after

Resume when renal function stable
FDA Changes to Metformin
Labeling29
eGFR level
Recommendation
Less than 30 ml/min per 1.73m2
-Contraindicated. Do NOT use.
-Discontinue if currently taking
<45 and > 30 ml/min per 1.73m2
-Assess the benefits and risks of
continuing treatment
-Do not start new patients on
metformin
Metformin and Renal Dosing:
Clinical Application


Possible implications

Decrease in medical costs

Delayed need for insulin

May decrease weight in some patients from net decrease in insulin
requirements
Other factors beyond renal impairment must be considered prior to
metformin initiation/continuation
TZDs and Bladder Cancer

12/12/2016

“Updated FDA review concludes that use of type 2 diabetes
medicine pioglitazone may be linked to an increased risk of bladder
cancer”31

Risk already included in current labeling

FDA approved label updates to include new data that has been
reviewed

Animal models have shown bladder tumors with pioglitazone
exposure32

Higher reporting of bladder cancer to FDA Adverse Event Reporting
System for pioglitazone than other diabetes treatment33

Human studies produced conflicting evidence
Is Pioglitazone Associated with a
Higher Risk of Bladder cancer?
Studies with significant risk

Lewis et al 5 year interim analysis34



Only in patients on pio >2 years
Hazard ratio 1.4 (CI 1.03-2.0)
Higher risk overall (HR1.63, 1.222.19)

Higher risk >2 years use (HR1.78,
1.21-2.64)

Dose response relation (p =0.01 for
trend)
Ferwana meta-analysis36

Overall risk (HR 1.23, CI 1.09-1.39)
Lewis et al 10 Year follow up
study37**

Tuccori et al35


Studies with no significant risk


No significant difference overall,
based on duration OR dose
PROactive trial38**

14/2605 in pio vs 6/2633 in placebo

P = 0.069

P = 0.309 when cases in first year
were removed
PROactive 10 year follow up39**

21 (1.2%) in pio vs 14 (0.8%) in
placebo, (RR 0.65, CI 0.33-1.28)
**denotes no significant risk but trend suggested higher risk in pio group
What Do We Make of All This?









Incidence of bladder cancer in pio and placebo is low
Causality cannot be confirmed
RCT study suggests no significant risk38
Risk in observational studies may be in part related to unequal
distribution of risk factors in pioglitazone vs placebo
Bladder cancer risk cannot be excluded
Until more definitive conclusions, must use caution and take heed of this
possible risk
Not recommended in patients with bladder cancer or a history of
bladder cancer
Recommend caution in family history of bladder cancer or other risk
factors for bladder cancer
Risk/benefit must be weighed on a patient specific basis
Counseling


Advise patients to seek attention if:

Blood in urine

New or worsening urge to urinate

Pain when urinating
Other counseling points

Edema

SOB

Weight gain
Reminders from 2016 FDA Alerts

With new medication benefits come new risks

Diabetes treatment selection is highly patient specific

Education is very important for patient safety
American Diabetes Association
2017 Updates40

Recommend periodic B12 monitoring in patients on metformin

Figure 8.1 updated to acknowledge high insulin costs
American Diabetes Association
2017 Updates40
Update to
Figure 8.2
American Diabetes Association
2017 Updates40
New Table 8.2
American Diabetes Association
2017 Updates40
New Table 8.3
American Diabetes Association
2017 Updates40

Recommendation to consider empagliflozin or liraglitide in patients with
history of cardiovascular disease to reduce risk of mortality

Section on new biosimilar insulins

Any of following recommended for hypertension treatment if no
albuminuria

ACEI/ARB

Thiazide diuretics

Dihydropyridine calcium channel blockers
American Diabetes Association
2017 Updates40


Specific recommendations added for treatment of neuropathic
pain

Pregabalin

Duloxetine
Inpatient diabetes management

Basal + correctional scale ok in non-critically ill patients but not
correctional scale alone
American Diabetes Association
2017 Updates40
American Diabetes Association
2017 Updates40

Non pharmacologic updates (included but not limited to)

Advise interruption of sitting every 30 minutes

Possibly discuss unifying DM classification scheme based on beta cell
function

Blood pressure targets for pregnant women changed:


120-160/80-105

optimize maternal health without inducing fetal harm
Recommendations added surrounding incorporating social considerations
into treatment decisions
Pharmacists’ Roles in Diabetes
COACH
https://timemanagementninja.com/2014/03/how-many-hats-are-you-trying-to-wear/
Potential Areas of Pharmacist
Impact in Diabetes
Medication-related



Proper

Timing

Administration

Storage
Hypoglycemia
Lifestyle/Other

Risks of poor DM control

Eating behaviors

Exercise

Lab monitoring

Signs and symptoms

Blood sugar testing

Treatment

Glucose/A1c targets

Lancets

Social support
Optimizing drug treatment

Safety

Efficacy

Cost
Questions?
References
1.
U.S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research.
Guidance for Industry: Diabetes Mellitus—Evaluating Cardiovascular risk in new antidiabetic therapies to treat type 2
diabetes. December 2008. Pages 1-5
2.
Smith RJ, Goldfine AB, Hiatt WR. Evaluating the cardiovascular safety of new medications for Type 2 diabetes: time to
reassess? Diabetes Care 2016;39:738-42.
3.
FDA Drug Safety Communication. FDA adds warning about heart failure risk to labels of type 2 diabetes medicines
containing saxagliptin and alogliptin. http://www.fda.gov/Drugs/DrugSafety/ucm486096.htm Issued 4/5/16, Accessed
12/2/16.
4.
Scirica BM, Bhatt DL, Braunwald E, et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus.
NEJM 2013;369:1317-26.
5.
Zannad F, Cannon CP, Cushman WC, et al. Heart failure and mortality outcomes in patients with type 2 diabetes taking
alogliptin versus placebo in EXAMINE: a multicenter, randomized, double blind trial. Lancet 2015; 285:2067-76.
6.
White WB, Cannon CP, Heller SR, et al. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. NEJM
2013;369:1327-35.
7.
Green JB, Bethel MA, Armstorng PW, et al. Effect of Sitagliptin on Cardiovascular Outcomes in Type 2 Diabetes. NEJM
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8.
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