Diabetes drug canagliflozin associated with amputation risk in older adults: BMJ

The authors propensity score-matched 1:1 patients newly prescribed canagliflozin with patients newly prescribed a glucagon-like peptide-1 (GLP-1) receptor agonist. Hazard ratios and rate differences per 1000 person-years were computed for the rate of lower limb amputation in the following four groups: group 1, patients aged less than 65 years without baseline cardiovascular disease; group 2, patients aged less than 65 with baseline cardiovascular disease; group 3, patients aged 65 or older without baseline cardiovascular disease; group 4, patients aged 65 or older with baseline cardiovascular disease.

The primary outcome measure was lower limb amputation requiring surgery. 

"Our results suggest that the increased amputation risk with canagliflozin is small and most obvious on an absolute scale among adults aged 65 or older having the cardiovascular disease at baseline, resulting in nearly four more amputations in 1000 person-years with canagliflozin than with a GLP-1 agonist, corresponding to a number needed to treat for an additional harmful outcome of 556 patients at six months," wrote the authors. "These findings help to contextualize the risk of amputation in routine care and can help patient-physician decision making before prescribing canagliflozin."

The study, "Risk of amputation with canagliflozin across categories of age and cardiovascular risk in three US nationwide databases: cohort study," is published in the journal BMJ.

DOI: https://doi.org/10.1136/bmj.m2812