1. New Diabetes Drug Invokana Has Major
Treatment - And Market - Potential
A new treatment option will soon be available to people with type 2 diabetes with the FDA’s
approval on Friday of Invokana, a first-in-class medication to lower blood sugar.
Johnson & Johnson’s Invokana (generic name canagliflozin) attacks blood sugar right from the
get go, reducing the amount of sugar absorbed from food into the bloodstream. The body then
flushes the excess sugar out in the urine.
The medical profession – and analysts – have been paying close attention to Invokana because it
lowers blood sugar by a different mechanism than the other diabetes drugs on the market.
(Metformin, which I wrote about last week for its anti-cancer and anti-aging benefits, is one of
the other popular diabetes medications available.)
Controlling blood sugar is the key to preventing the many side effects caused by diabetes, such
as vision loss, nerve damage, kidney damage, and increased risk of heart attack and stroke.
Johnson & Johnson’s application for Invokana cited nine clinical trials involving more than
10,000 patients. The main side effects found were urinary tract infections (UTIs) and yeast
infections caused by large amounts of sugar in the urine. (Women prone to UTIs are familiar
with this problem.) Forbes’ Matthew Herper reports that this problem could limit Invokana’s
sales, according to some analysts’ predictions. People taking Invokana were also found to have
the potential to become dizzy or faint when standing up suddenly, giving the drug the potential to
cause falls, which can be particularly dangerous to the elderly.
Invokana’s action takes place in the kidneys – it blocks an enzyme, sodium-glucose co-
transporter 2, from putting sugar removed by the kidneys back in the bloodstream. Therefore
some members of the FDA’s advisory panel expressed concern that Invokana should not be
taken by people with moderate to severe kidney disease.
Invokana was found in trials to raise cholesterol, both LDL or bad cholesterol and HDL, or
“good” cholesterol. An elevated risk of stroke and heart attack was found in the first 30 days
after starting the medication, but after 30 days Invokana reduced these risks.
Some diabetes drugs, in particular the former “blockbuster” Avandia, have run into trouble
because of increased heart attack risk. Avandia is now restricted to patients who’ve tried and
failed to respond to other medications, and is banned in Europe. The FDA required Johnson &
Johnson to conduct five additional long-term studies of Invokana’s effects on cardiac health,
liver problems, cancer, and pancreatic disease.
Any diabetes drug that works well – and has limited side effects – has major market potential
simply because there are so many people with diabetes.