Trial reportThe New England journal of medicine2017

Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes.

Bruce Neal, Vlado Perkovic, Kenneth W Mahaffey, Dick de Zeeuw, Greg Fulcher, Ngozi Erondu, Wayne Shaw, Gordon Law, Mehul Desai, David R Matthews and 1 more

13 registry-linked trialsAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in The New England journal of medicine, 2017. The graph read 3 numbers from its abstract, feeding 2 cells of the map: it . It reports registered trial NCT01032629. Cited by 3,183 papers, 21 of them syntheses that pooled it.

3numbers the graph read from it
1cell of the map it votes in
3,183citing papers in PubMed, 21 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

← favours the treatmentfavours the comparator →
21 · no effect
Cardiovascular eventsfavours the comparator · head-to-head · ckd, ascvdfeeds one cell of the map
HR 1.971.41 to 2.75
Adverse reactions were consistent with the previously reported risks associated with canagliflozin except for an increased risk of amputation (6.3 vs. 3.4 participants per 1000 patient-years; hazard ratio, 1.97; 95% CI, 1.41 to 2.75); amputations were primarily at the level of the toe or metatarsal.

Read, but not usablea number the graph found but could not read as for or against

Kidney outcomescomparator not stated · ckd, ascvdfeeds one cell of the map
HR 0.730.67 to 0.79
Although on the basis of the prespecified hypothesis testing sequence the renal outcomes are not viewed as statistically significant, the results showed a possible benefit of canagliflozin with respect to the progression of albuminuria (hazard ratio, 0.73; 95% CI, 0.67 to 0.79) and the composite outcome of a sustained 40% reduction in the estimated glomerular filtration rate, the need for renal-replacement therapy, or death from renal causes (hazard ratio, 0.60; 95% CI, 0.47 to 0.77).
Cardiovascular eventscomparator not stated · ckd, ascvdfeeds one cell of the map
HR 0.600.47 to 0.77
Although on the basis of the prespecified hypothesis testing sequence the renal outcomes are not viewed as statistically significant, the results showed a possible benefit of canagliflozin with respect to the progression of albuminuria (hazard ratio, 0.73; 95% CI, 0.67 to 0.79) and the composite outcome of a sustained 40% reduction in the estimated glomerular filtration rate, the need for renal-replacement therapy, or death from renal causes (hazard ratio, 0.60; 95% CI, 0.47 to 0.77).

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

SGLT2 inhibitors×cardiovascular events

No readable resultOpen on the map →What to test next →

22 readable studies in this cell: 9 favour the treatment, 10 find no difference, 3 favour the comparator.

Belief with this paper
0.50contested · 9 families support, 6 contradict · against placebo
Without it
0.50This paper does not move the number.
← favours the treatmentfavours the comparator →
1 · no effect
This paper’s trial, registry resultNCT01989754 · 5,813 enrolled · 2014
HR 0.720.55 to 0.94
This paper4,330 enrolled · 2009
HR 1.971.41 to 2.75
NCT0546531762,197 enrolled · 2022
HR 0.750.65 to 0.86
NCT0399313226,774 enrolled · 2018
HR 1.010.91 to 1.11
NCT0173053417,190 enrolled · 2013
HR 0.930.84 to 1.03
NCT0493781616,746 enrolled · 2021
HR 1.000.83 to 1.20
NCT045096746,522 enrolled · 2020
HR 0.900.76 to 1.06
NCT036192136,263 enrolled · 2018
HR 0.820.73 to 0.92
NCT030579515,988 enrolled · 2017
HR 0.790.69 to 0.90
NCT020657914,401 enrolled · 2014
HR 0.700.59 to 0.82
NCT045647424,017 enrolled · 2020
Win Ratio (WR) 1.341.20 to 1.50
NCT030579773,730 enrolled · 2017
HR 0.750.65 to 0.86
NCT043636972,401 enrolled · 2020
HR 0.860.68 to 1.08
NCT04157751530 enrolled · 2020
Stratified Win Ratio 1.361.09 to 1.68

SGLT2 inhibitors×kidney outcomes

No readable resultOpen on the map →What to test next →

13 readable studies in this cell: 10 favour the treatment, 1 find no difference, 2 favour the comparator.

Belief with this paper
0.89established · 8 families support, 1 contradict · against placebo
Without it
0.88This paper moves it by +0.01.
← favours the treatmentfavours the comparator →
1 · no effect
This paper’s trial, registry resultNCT01989754 · 5,813 enrolled · 2014
HR 0.640.57 to 0.73
This paper’s trial, registry resultNCT01032629 · 4,330 enrolled · 2009
OR 0.800.67 to 0.97
NCT02864914333,580 enrolled · 2016
IRR 0.690.45 to 1.05
NCT0546531762,197 enrolled · 2022
HR 0.750.65 to 0.86
NCT0173053417,190 enrolled · 2013
HR 0.760.67 to 0.87
NCT030579515,988 enrolled · 2017
Treatment by time interaction 1.360.86 to 1.86
NCT020657914,401 enrolled · 2014
HR 0.700.59 to 0.82
NCT030579773,730 enrolled · 2017
Treatment by time interaction 1.730.67 to 2.80
4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01032629 phase3completed

A Randomized, Multicenter, Double-Blind, Parallel, Placebo-Controlled Study of the Effects of JNJ-28431754 on Cardiovascular Outcomes in Adult Subjects With Type 2 Diabetes Mellitus

Ran2009Enrolled4,330Registered outcomes13Posted comparisons33ConditionsCardiovascular Diseases, Diabetes Mellitus, Type 2, Risk FactorsArmsCanagliflozin (JNJ-28431754) 100 mg, Canagliflozin (JNJ-28431754) 300 mg, Placebo
Open the trial in the graph
NCT01989754 phase4completed

A Randomized, Multicenter, Double-Blind, Parallel, Placebo-Controlled Study of the Effects of Canagliflozin on Renal Endpoints in Adult Subjects With Type 2 Diabetes Mellitus

Ran2014Enrolled5,813Registered outcomes3Posted comparisons3ConditionsAlbuminuria, Diabetes Mellitus, Type 2ArmsCanagliflozin, 100 mg, Canagliflozin, 300 mg, Placebo
Open the trial in the graph
NCT04717986 nacompletedstarted 2021, after this paper: background citation

Dapagliflozin Effects on Mayor Adverse Cardiovascular Events in Patients With Acute Myocardial Infarction (DAPA-AMI). Randomized Clinical Trial

Ran2021Enrolled188Registered outcomes5Posted comparisons0ConditionsAcute Myocardial Infarction, Angina, Unstable, Cardiovascular Morbidity, Heart FailureArmsDapagliflozin 10mg Tab, Placebo
Open the trial in the graph
NCT04906213 phase2terminatedstarted 2022, after this paper: background citation

CardioRenal Effects of SGLT2 Inhibition in Kidney Transplant Recipients

Ran2022Enrolled20Registered outcomes10Posted comparisons0ConditionsDiabetes Mellitus, Type 2, Kidney Transplant; ComplicationsArmsEmpagliflozin10Mg Tab, Placebo
Open the trial in the graph
NCT05367063 phase4completedstarted 2022, after this paper: background citation

Canagliflozin Attenuates CMR-Quantified Myocardial Fibrosis in Patients With Type 2 Diabetes Mellitus at High Cardiovascular Risk

Ran2022Enrolled45Registered outcomes3Posted comparisons0ConditionsCardiovascular Risk, Type 2 DiabetesArmsCanagliflozin 100mg or Sitagliptin 100mg
Open the trial in the graph
NCT05477017 unknown statusstarted 2022, after this paper: background citation

Prospective Observational Cohort Study to Evaluate the Benefits, Documented in the Experimental Settings, of Treatment With SGLT2-i in Normal Clinical Practice, in Subjects With Type 2 Diabetes and Older Than 70 Years.

Ran2022Enrolled800Registered outcomes11Posted comparisons0ConditionsType2DiabetesArmsSGLT2 inhibitor
Open the trial in the graph
NCT05741658 phase4completedstarted 2023, after this paper: background citation

An Open-Label, Non-randomized, Multi-center Pilot Study to Evaluate the Safety and Efficacy of 4-week, Daily Oral Use of Dapagliflozin 10mg Tablet in Adults With a Fontan Circulation

Ran2023Enrolled29Registered outcomes8Posted comparisons0ConditionsHeart FailureArmsDapagliflozin 10mg Tab
Open the trial in the graph
NCT06286878 phase2 / phase3recruitingstarted 2021, after this paper: background citation

Pleiotropic Effects of Dapagliflozin in Patients With Acute Coronary Syndromes

Ran2021Enrolled80Registered outcomes4Posted comparisons0ConditionsAcute Coronary Syndrome, Diabetes, Myocardial Infarction, Ventricular DysfunctionArmsdapagliflozin, Placebo
Open the trial in the graph
NCT04780438 early_phase1unknown statusnot on this mapstarted 2021, after this paper: background citation

Dapagliflozin to Prevent Atrial Fibrillation Recurrence After Transcatheter Pulmonary Venous Isolation.

TypeinterventionalSponsorG.Gennimatas General HospitalRan2021 to 2023Enrolled350ConditionsAtrial Fibrillation Recurrent, Pulmonary Venous Isolation, Catheter Ablation, Sodium-glucose Co-transporter 2 InhibitorsArmsDapagliflozin, Placebo
NCT05047471 unknown statusnot on this mapstarted 2021, after this paper: background citation

Healthy China - The Improvement Projects for the Screening Ability of Diabetes and Its Complications And for the Standardized Ability of Diagnosis and Treatment for Patients With Early Diabetic Nephropathy

TypeobservationalSponsorYiming MuRan2021 to 2023Enrolled10,000ConditionsDiabetic Kidney Disease
NCT05349955 narecruitingnot on this mapstarted 2022, after this paper: background citation

Effects and Safety of GUideline Algorithm Based Intervention on CaRdiovascular and Renal Outcomes in Elderly Diabetic Patients With High Cardiovascular Risk in the Community- A Cluster Randomized Controlled Trial (GUARD-Community Study)

TypeinterventionalSponsorShanghai Zhongshan HospitalRan2022 to 2026Enrolled5,600ConditionsType 2 Diabetes, Cardiovascular Complication, Diabetic Kidney DiseaseArmsIntensive guideline algorithm implementation, Conventional guideline algorithm implementation
NCT05424315 phase2 / phase3completednot on this mapstarted 2021, after this paper: background citation

Impact of DApagliflozin on Cardiac Function Following Anterior Myocardial Infarction in Non-Diabetic Patients - DACAMI (a Randomized Controlled Clinical Trial)

TypeinterventionalSponsorOmar YounisRan2021 to 2022Enrolled100ConditionsAnterior MIArmsDapagliflozin 10mg, Glucose Tab
NCT06473844 narecruitingnot on this mapstarted 2025, after this paper: background citation

Efficacy and Safety of Sodium-Glucose Cotransporter 2 Inhibitors in Adults With Sepsis: A Feasibility Study for a Multicenter Double-Blind Randomized Placebo-Controlled Trial

TypeinterventionalSponsorHospital Authority, Hong KongRan2025 to 2027Enrolled60ConditionsSepsis, Inflammation, SGLT2 Inhibitors, Critically IllArmsEmpagliflozin 10 MG, Placebo
5 · Its place in the literature

Who cites it

3,183 citing papers in PubMed, 21 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Guideline
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Guideline
  9. Guideline
  10. Pooled it
  11. Pooled it
  12. Pooled it
  13. Pooled it
  14. Pooled it
  15. Guideline
  16. Guideline
  17. Pooled it
  18. Pooled it
  19. Pooled it
  20. Pooled it

3,123 more citing papers are in PubMed but not listed here.

6 · The record

Corrections and comments

7 · Who and what money

Authors and funding

11 authors.

Bruce NealFrom the George Institute for Global Health, Faculty of Medicine, UNSW Sydney (B.N., V.P.), the Charles Perkins Centre (B.N.), and the Royal North Shore Hospital (V.P., G.F.), University of Sydney, and the Faculty of Medicine, University of New South Wales (B.N.) - all in Sydney; Imperial College London, London (B.N.), and the Oxford Centre for Diabetes, Endocrinology, and Metabolism and Harris Manchester College, University of Oxford, Oxford (D.R.M.) - both in the United Kingdom; the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA (K.W.M.); the University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (D.Z.); and Janssen Research and Development, Raritan, NJ (N.E., W.S., G.L., M.D.).
Vlado PerkovicFrom the George Institute for Global Health, Faculty of Medicine, UNSW Sydney (B.N., V.P.), the Charles Perkins Centre (B.N.), and the Royal North Shore Hospital (V.P., G.F.), University of Sydney, and the Faculty of Medicine, University of New South Wales (B.N.) - all in Sydney; Imperial College London, London (B.N.), and the Oxford Centre for Diabetes, Endocrinology, and Metabolism and Harris Manchester College, University of Oxford, Oxford (D.R.M.) - both in the United Kingdom; the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA (K.W.M.); the University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (D.Z.); and Janssen Research and Development, Raritan, NJ (N.E., W.S., G.L., M.D.).
Kenneth W MahaffeyFrom the George Institute for Global Health, Faculty of Medicine, UNSW Sydney (B.N., V.P.), the Charles Perkins Centre (B.N.), and the Royal North Shore Hospital (V.P., G.F.), University of Sydney, and the Faculty of Medicine, University of New South Wales (B.N.) - all in Sydney; Imperial College London, London (B.N.), and the Oxford Centre for Diabetes, Endocrinology, and Metabolism and Harris Manchester College, University of Oxford, Oxford (D.R.M.) - both in the United Kingdom; the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA (K.W.M.); the University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (D.Z.); and Janssen Research and Development, Raritan, NJ (N.E., W.S., G.L., M.D.).
Dick de ZeeuwFrom the George Institute for Global Health, Faculty of Medicine, UNSW Sydney (B.N., V.P.), the Charles Perkins Centre (B.N.), and the Royal North Shore Hospital (V.P., G.F.), University of Sydney, and the Faculty of Medicine, University of New South Wales (B.N.) - all in Sydney; Imperial College London, London (B.N.), and the Oxford Centre for Diabetes, Endocrinology, and Metabolism and Harris Manchester College, University of Oxford, Oxford (D.R.M.) - both in the United Kingdom; the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA (K.W.M.); the University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (D.Z.); and Janssen Research and Development, Raritan, NJ (N.E., W.S., G.L., M.D.).
Greg FulcherFrom the George Institute for Global Health, Faculty of Medicine, UNSW Sydney (B.N., V.P.), the Charles Perkins Centre (B.N.), and the Royal North Shore Hospital (V.P., G.F.), University of Sydney, and the Faculty of Medicine, University of New South Wales (B.N.) - all in Sydney; Imperial College London, London (B.N.), and the Oxford Centre for Diabetes, Endocrinology, and Metabolism and Harris Manchester College, University of Oxford, Oxford (D.R.M.) - both in the United Kingdom; the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA (K.W.M.); the University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (D.Z.); and Janssen Research and Development, Raritan, NJ (N.E., W.S., G.L., M.D.).
Ngozi EronduFrom the George Institute for Global Health, Faculty of Medicine, UNSW Sydney (B.N., V.P.), the Charles Perkins Centre (B.N.), and the Royal North Shore Hospital (V.P., G.F.), University of Sydney, and the Faculty of Medicine, University of New South Wales (B.N.) - all in Sydney; Imperial College London, London (B.N.), and the Oxford Centre for Diabetes, Endocrinology, and Metabolism and Harris Manchester College, University of Oxford, Oxford (D.R.M.) - both in the United Kingdom; the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA (K.W.M.); the University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (D.Z.); and Janssen Research and Development, Raritan, NJ (N.E., W.S., G.L., M.D.).
Wayne ShawFrom the George Institute for Global Health, Faculty of Medicine, UNSW Sydney (B.N., V.P.), the Charles Perkins Centre (B.N.), and the Royal North Shore Hospital (V.P., G.F.), University of Sydney, and the Faculty of Medicine, University of New South Wales (B.N.) - all in Sydney; Imperial College London, London (B.N.), and the Oxford Centre for Diabetes, Endocrinology, and Metabolism and Harris Manchester College, University of Oxford, Oxford (D.R.M.) - both in the United Kingdom; the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA (K.W.M.); the University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (D.Z.); and Janssen Research and Development, Raritan, NJ (N.E., W.S., G.L., M.D.).
Gordon LawFrom the George Institute for Global Health, Faculty of Medicine, UNSW Sydney (B.N., V.P.), the Charles Perkins Centre (B.N.), and the Royal North Shore Hospital (V.P., G.F.), University of Sydney, and the Faculty of Medicine, University of New South Wales (B.N.) - all in Sydney; Imperial College London, London (B.N.), and the Oxford Centre for Diabetes, Endocrinology, and Metabolism and Harris Manchester College, University of Oxford, Oxford (D.R.M.) - both in the United Kingdom; the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA (K.W.M.); the University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (D.Z.); and Janssen Research and Development, Raritan, NJ (N.E., W.S., G.L., M.D.).
Mehul DesaiFrom the George Institute for Global Health, Faculty of Medicine, UNSW Sydney (B.N., V.P.), the Charles Perkins Centre (B.N.), and the Royal North Shore Hospital (V.P., G.F.), University of Sydney, and the Faculty of Medicine, University of New South Wales (B.N.) - all in Sydney; Imperial College London, London (B.N.), and the Oxford Centre for Diabetes, Endocrinology, and Metabolism and Harris Manchester College, University of Oxford, Oxford (D.R.M.) - both in the United Kingdom; the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA (K.W.M.); the University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (D.Z.); and Janssen Research and Development, Raritan, NJ (N.E., W.S., G.L., M.D.).
David R MatthewsFrom the George Institute for Global Health, Faculty of Medicine, UNSW Sydney (B.N., V.P.), the Charles Perkins Centre (B.N.), and the Royal North Shore Hospital (V.P., G.F.), University of Sydney, and the Faculty of Medicine, University of New South Wales (B.N.) - all in Sydney; Imperial College London, London (B.N.), and the Oxford Centre for Diabetes, Endocrinology, and Metabolism and Harris Manchester College, University of Oxford, Oxford (D.R.M.) - both in the United Kingdom; the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Stanford, CA (K.W.M.); the University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (D.Z.); and Janssen Research and Development, Raritan, NJ (N.E., W.S., G.L., M.D.).
CANVAS Program Collaborative Group

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

Background Canagliflozin is a sodium-glucose cotransporter 2 inhibitor that reduces glycemia as well as blood pressure, body weight, and albuminuria in people with diabetes. We report the effects of treatment with canagliflozin on cardiovascular, renal, and safety outcomes. Methods The CANVAS Program integrated data from two trials involving a total of 10,142 participants with type 2 diabetes and high cardiovascular risk. Participants in each trial were randomly assigned to receive canagliflozin or placebo and were followed for a mean of 188.2 weeks. The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Results The mean age of the participants was 63.3 years, 35.8% were women, the mean duration of diabetes was 13.5 years, and 65.6% had a history of cardiovascular disease. The rate of the primary outcome was lower with canagliflozin than with placebo (occurring in 26.9 vs. 31.5 participants per 1000 patient-years; hazard ratio, 0.86; 95% confidence interval [CI], 0.75 to 0.97; P<0.001 for noninferiority; P=0.02 for superiority). Although on the basis of the prespecified hypothesis testing sequence the renal outcomes are not viewed as statistically significant, the results showed a possible benefit of canagliflozin with respect to the progression of albuminuria (hazard ratio, 0.73; 95% CI, 0.67 to 0.79) and the composite outcome of a sustained 40% reduction in the estimated glomerular filtration rate, the need for renal-replacement therapy, or death from renal causes (hazard ratio, 0.60; 95% CI, 0.47 to 0.77). Adverse reactions were consistent with the previously reported risks associated with canagliflozin except for an increased risk of amputation (6.3 vs. 3.4 participants per 1000 patient-years; hazard ratio, 1.97; 95% CI, 1.41 to 2.75); amputations were primarily at the level of the toe or metatarsal. Conclusions In two trials involving patients with type 2 diabetes and an elevated risk of cardiovascular disease, patients treated with canagliflozin had a lower risk of cardiovascular events than those who received placebo but a greater risk of amputation, primarily at the level of the toe or metatarsal. (Funded by Janssen Research and Development; CANVAS and CANVAS-R ClinicalTrials.gov numbers, NCT01032629 and NCT01989754 , respectively.).

Indexed as

AgedAlbuminuriaAmputation, SurgicalCanagliflozinCardiovascular DiseasesDiabetes Mellitus, Type 2Disease ProgressionFemaleFootGlomerular Filtration RateHospitalizationHumansHypoglycemic AgentsKidney DiseasesMaleMiddle AgedCanagliflozinHypoglycemic Agents

Identifiers

PMID28605608

What Socratic holds

Texttitle and abstract
Read underepoch 390

Registered trials

and 7 more above

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.