Jump to content

Dapagliflozin

From Wikipedia, the free encyclopedia

Dapagliflozin
Haworth projection (bottom)
Clinical data
Pronunciation/ˌdæpəɡlɪˈfloʊzɪn/ DAP-ə-glif-LOH-zin
Trade namesFarxiga, Forxiga, others
Other namesBMS-512148; (1S)-1,5-anhydro-1-C-{4-chloro-3-[(4-ethoxyphenyl)methyl]phenyl}-D-glucitol
AHFS/Drugs.comMonograph
MedlinePlusa614015
License data
Pregnancy
category
Routes of
administration		By mouth
Drug classSodium-glucose co-transporter 2 (SGLT2) inhibitor
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability78% (after 10 mg dose)
Protein binding~91%
MetabolismUGT1A9 (major), CYP (minor)
MetabolitesDapagliflozin 3-O-glucuronide (inactive)
Elimination half-life~12.9 hours
ExcretionUrine (75%), feces (21%)[6]
Identifiers
  • (2S,3R,4R,5S,6R)-2-[4-Chloro-3-(4-ethoxybenzyl)phenyl]-6-(hydroxymethyl)tetrahydro-2H-pyran-3,4,5-triol
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.167.331 Edit this at Wikidata
Chemical and physical data
FormulaC21H25ClO6
Molar mass408.88 g·mol−1
3D model (JSmol)
  • Clc1ccc(cc1Cc2ccc(OCC)cc2)[C@@H]3O[C@H](CO)[C@@H](O)[C@H](O)[C@H]3O
  • InChI=1S/C21H25ClO6/c1-2-27-15-6-3-12(4-7-15)9-14-10-13(5-8-16(14)22)21-20(26)19(25)18(24)17(11-23)28-21/h3-8,10,17-21,23-26H,2,9,11H2,1H3/t17-,18-,19+,20-,21+/m1/s1
  • Key:JVHXJTBJCFBINQ-ADAARDCZSA-N

Dapagliflozin, sold under the brand names Farxiga (US) and Forxiga (EU) among others, is a medication used to treat type 2 diabetes.[6][7][10] It is also used to treat adults with heart failure and chronic kidney disease.[11][12][7] It reversibly inhibits sodium-glucose co-transporter 2 (SGLT-2) in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion.[13]

Common side effects include hypoglycaemia (low blood sugar), urinary tract infections, genital infections, and volume depletion (reduced amount of water in the body).[14] Diabetic ketoacidosis is a common side effect in people with type 1 diabetes.[15] Serious but rare side effects include Fournier gangrene.[16]

It was developed by Bristol-Myers Squibb in partnership with AstraZeneca. It is on the World Health Organization's List of Essential Medicines.[17] In 2022, it was the 115th most commonly prescribed medication in the United States, with more than 5 million prescriptions.[18][19] Dapagliflozin is available as a generic medication.[20]

Medical uses

[edit]

Dapagliflozin is used along with diet, exercise, and usually with other glucose-lowering medications, to improve glycaemic control in adults with type 2 diabetes. Dapagliflozin, in addition to other SGLT2-inhibitors, was shown to reduce the rate of decline in kidney function and kidney failure in non-diabetic and type 2 diabetic adults when added to the existing treatment regimen.[21][22][23][24]

Dapagliflozin is also considered as an option for people with heart failure with reduced ejection fraction with a LVEF <40%.[25] It can be given regardless of current diabetes status, in addition to standard medical therapy. Recent studies have indicated that the use of dapagliflozin and other medications from the SGLT-2 inhibitor class can reduce the risk of worsening heart failure, death, and hospitalization from cardiovascular disease.[25][26] SGLT-2 inhibitors reduce the risk of hospitalisation due to heart failure in people with or without atherosclerotic cardiovascular disease [27][28] A small number of meta-analyses and cohort studies have shown that dapagliflozin is superior to others such as empagliflozin.[29][30][31]

In the European Union, dapagliflozin is indicated in adults:[32]

  • for the treatment of insufficiently controlled type 2 diabetes as an adjunct to diet and exercise:[7][32][33][34][35]
    • as monotherapy when metformin is considered inappropriate due to intolerance;[7][32][33][34][35]
    • in addition to other medicinal products for the treatment of type 2 diabetes;[7][32]
  • for the treatment of symptomatic chronic heart failure;[7][32]
  • for the treatment of the treatment of chronic kidney disease[7][32]

In November 2021, the European Medicines Agency (EMA) stated that dapagliflozin should no longer be used to treat type 1 diabetes.[10]

Effects in nondiabetic chronic kidney disease

[edit]

In 2021, the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) expanded the indications for dapagliflozin to include the treatment of people who have chronic kidney disease but do not have diabetes.[36][37]

Clinical trials have shown the following effects of such a treatment.

The DIAMOND trial (2017–2019) showed in treatment periods of six weeks no improvement of excess proteins in the urine (proteinuria), a significant deterioration of the kidney's filtration rate (reversible within 6 weeks after dapagliflozin discontinuation), and a significant mean loss of body weight of 1.5 kg.[38][39]

The DAPA-CKD trial (2017–2020) showed in a median treatment period of 2.4 years of participants who had already been under ACE inhibitor (ACE) or angiotensin II receptor blocker (ARB) therapy that the events of a sustained decline of 50% in the kidney's filtration rate, kidney failure, or death occurred statistically around eight months later in the treatment group than in the placebo group. In the first 12-16 months of treatment, however, the kidney filtration rate was worse in the treatment group than in the placebo group, being slightly less negative in the treatment group than in the placebo group only thereafter.[22][39]

Adverse effects

[edit]

Since dapagliflozin leads to heavy glycosuria (sometimes up to about 70 grams per day), it can lead to rapid weight loss and tiredness. The glucose acts as an osmotic diuretic (this effect is the cause of polyuria in diabetes), which can lead to dehydration. The increased amount of glucose in the urine can also worsen the infections already associated with diabetes, particularly urinary tract infections and thrush (candidiasis). Rarely, the use of an SGLT-2 inhibitor medication, including dapagliflozin, is associated with necrotizing fasciitis of the perineum, also called Fournier gangrene.[40]

Dapagliflozin is also associated with hypotensive reactions. Concerns exist that it may increase the risk of diabetic ketoacidosis.[41] Dapagliflozin and other SGLT2 inhibitors increase the risk of diabetic ketoacidosis in type 2 diabetic patients.[42][43] However, the DEPICT-1 and DEPICT-2 trials showed that dapagliflozin caused additional diabetic ketoacidosis events in the Type I diabetic patients who received dapagliflozin.[44] Symptoms of ketoacidosis include nausea, vomiting, abdominal pain, fatigue, and trouble breathing.[45]

Dapagliflozin can cause dehydration, serious urinary tract infections, and genital yeast infections.[11] Elderly people and people with kidney dysfunction, low blood pressure, or who are on diuretic medications should have their volume status and kidney function assessed.[11] Individuals with signs and symptoms of metabolic acidosis or ketoacidosis should also be assessed.[11] Dapagliflozin can cause low blood sugar when combined with insulin.[11]

To lessen the risk of developing ketoacidosis after surgery, the US Food and Drug Administration (FDA) approved changes to the prescribing information for SGLT-2 inhibitors to recommend they be stopped temporarily before scheduled surgery. Canagliflozin, dapagliflozin, and empagliflozin should each be stopped at least three days before, and ertugliflozin should be stopped at least four days before scheduled surgery.[45]

The glucose-lowering effect of dapagliflozin starts to diminish in people with chronic kidney disease with reduced kidney function (eGFR <45mL/min), and may not be as effective for glycemic control. However, studies have demonstrated a renoprotective effect in reducing kidney function decline, dapagliflozin can still be used to reduce kidney function decline regardless of diabetes status. Therefore, while dapagliflozin can be used in people with diabetes and chronic kidney disease to prevent kidney function decline, further interventions may be needed for glycemic control.[22][46]

Chemistry

[edit]

The first synthesis of dapagliflozin was disclosed in a patent filed by Bristol Myers Squibb in 2002.[47]

Synthesis of dapaglifloxin

The two main carbon-containing fragments are combined by the reaction of an aryl lithium with a trimethylsilyl-protected gluconolactone. The trimethylsilyl groups are then removed by treatment with methanesulfonic acid in methanol. This gives an intermediate with an unwanted methoxy group at the anomeric centre, which is removed by reaction with triethylsilane in the presence of boron trifluoride etherate. This route, as well as others developed for the manufacture of the drug, have been reviewed.[48]

Mechanism of action

[edit]

Dapagliflozin inhibits subtype 2 of the sodium-glucose transport proteins (SGLT2), which are responsible for at least 90% of the glucose reabsorption in the kidney. Blocking this transporter mechanism causes blood glucose to be eliminated through the urine.[49] In combination with metformin, dapagliflozin at standard treatment dose of 10 mg daily lowered HbA1c by 0.54-0.84% (5.9-9.3 mmol/mol) when compared to metformin monotherapy in patients with inadequately controlled type 2 diabetes and normal renal function.[50][51][52]

Its protective effects in heart failure are attributed primarily to haemodynamic effects, where SGLT2 inhibitors potently reduce intravascular volume through osmotic diuresis and natriuresis. This consequently may lead to a reduction in preload and afterload, thereby alleviating cardiac workload and improving left ventricular function.[53]

Selectivity

[edit]

The IC50 for SGLT2 is less than one-thousandth of the IC50 for SGLT1 (1.1 versus 1390 nmol/L), so that the drug does not interfere with intestinal glucose absorption.[54]

Names

[edit]

Dapagliflozin is the International nonproprietary name (INN),[55] and the United States Adopted Name (USAN).[56]

The fixed-dose combination product, dapagliflozin/metformin extended-release, is sold under the brand name Xigduo XR.[57][58][59]

In July 2016, the fixed-dose combination of saxagliptin and dapagliflozin was authorized for medical use in the European Union and is sold under the brand name Qtern.[60] The combination drug was approved for medical use in the United States in February 2017, where it also is sold under the brand name Qtern.[61][62]

In May 2019, the fixed-dose combination of dapagliflozin, saxagliptin, and metformin hydrochloride as extended-release tablets was approved in the United States to improve glycemic control in adults with type 2 diabetes when used in combination with diet and exercise. The FDA granted the approval of Qternmet XR to AstraZeneca.[63] The combination drug was authorized for use in the European Union in November 2019, and is sold under the brand name Qtrilmet.[64]

History

[edit]

In 2012, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) issued a positive opinion on the drug.[7]

Dapagliflozin was found effective in several studies in participants with type 2 diabetes.[7] The main measure of effectiveness was the level of glycated haemoglobin (HbA1c), which indicates how well blood glucose is controlled.[7]

In two studies involving 840 participants with type 2 diabetes, dapagliflozin when used alone decreased HbA1c levels by 0.66% more than placebo (a dummy treatment) after 24 weeks.[7] In four other studies involving 2,370 participants, adding dapagliflozin to other diabetes medicines decreased HbA1c levels by 0.54–0.68% more than adding placebo after 24 weeks.[7]

In a study involving 814 participants with type 2 diabetes, dapagliflozin used in combination with metformin was at least as effective as a sulphonylurea (another type of diabetes medicine) used with metformin.[7] Both combinations reduced HbA1c levels by 0.52% after 52 weeks.[7]

A long-term study, involving over 17,000 participants with type 2 diabetes, looked at the effects of dapagliflozin on cardiovascular (heart and circulation) disease.[7] The study indicated that dapagliflozin's effects were in line with those of other diabetes medicines that also work by blocking SGLT2.[7]

In two studies involving 1,648 participants with type 1 diabetes whose blood sugar was not controlled well enough on insulin alone, adding dapagliflozin 5 mg decreased HbA1c levels after 24 hours by 0.37% and by 0.42% more than adding placebo.[7]

Dapagliflozin was authorized for medical use in the European Union in November 2012.[7] It is sold in a number of European countries.[65]

Dapagliflozin was approved for medical use in the United States in January 2014.[66][36]

In 2020, the US FDA expanded the indications for dapagliflozin to include treatment for adults with heart failure with reduced ejection fraction to reduce the risk of cardiovascular death and hospitalization for heart failure.[11] It is the first in this particular drug class, sodium-glucose co-transporter 2 inhibitors, to be approved to treat adults with New York Heart Association's functional class II-IV heart failure with reduced ejection fraction.[11]

The results of the DAPA-HF and DECLARE-TIMI 58 clinical trials demonstrated the efficacy of dapagliflozin compared to placebo in improving survival in adults with heart failure with reduced ejection fraction by 17%. They both showed a reduction in the number of hospitalizations from worsening heart failure, cardiovascular death and all-cause mortality.[25][67]

The safety and effectiveness of dapagliflozin were evaluated in a randomized, double-blind, placebo-controlled study of 4,744 participants.[11] The average age of participants was 66 years and more participants were male (77%) than female.[11] To determine the drug's effectiveness, investigators examined the occurrence of cardiovascular death, hospitalization for heart failure, and urgent heart failure visits.[11] Participants were randomly assigned to receive a once-daily dose of either 10 mg of dapagliflozin or a placebo (inactive treatment).[11] After about 18 months, people who received dapagliflozin had fewer cardiovascular deaths, hospitalizations for heart failure, and urgent heart-failure visits than those receiving the placebo.[11]

In July 2020, the FDA granted AstraZeneca a Fast Track Designation in the US for the development of dapagliflozin to reduce the risk of hospitalization for heart failure or cardiovascular death in adults following a heart attack.[68]

In August 2020, detailed results from the Phase III DAPA-CKD trial reportedly showed that dapagliflozin on top of standard of care reduced the composite measure of worsening of renal function or risk of cardiovascular or renal death by 39% compared to placebo (p<0.0001) in patients with chronic kidney disease stages 2–4 and elevated urinary albumin excretion. The results were consistent in patients both with and without type 2 diabetes.[69]

In April 2021, the FDA expanded the indications for dapagliflozin to include reducing the risk of kidney function decline, kidney failure, cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease who are at risk of disease progression.[36] The efficacy of dapagliflozin to improve kidney outcomes and reduce cardiovascular death in people with chronic kidney disease was evaluated in a multicenter, double-blind study of 4,304 participants.[36]

In February 2023, the EU authorized dapagliflozin for extended use to cover heart failure patients across the full spectrum of left ventricular ejection fraction (LVEF), including those with mildly reduced and preserved ejection fraction.[70][71]

Society and culture

[edit]
[edit]

A generic version of dapagliflozin was approved by the US FDA in February 2022,[72] but cannot be sold until October 2025.[73][74] A generic version was approved in Canada in May 2023.[75]

In January 2023, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) adopted a positive opinion, recommending the granting of a marketing authorization for a generic version of Forxiga, which has been authorized in the EU since November 2012.[76] Dapagliflozin Viatris was authorized for medical use in the European Union in March 2023.[8]

Research

[edit]

A systematic review concluded that dapagliflozin reduced heart failure hospitalization, cardiovascular death, and all-cause mortality in people with HFrEF (i.e., congestive heart failure) and diabetes.[77]

References

[edit]
  1. ^ "Dapagliflozin (Farxiga) Use During Pregnancy". Drugs.com. 30 August 2018. Archived from the original on 17 April 2021. Retrieved 5 May 2020.
  2. ^ "Forxiga dapagliflozin (as propanediol monohydrate) 10 mg film-coated tablet blister pack (180147)". Therapeutic Goods Administration (TGA). 27 May 2022. Retrieved 20 April 2024.
  3. ^ "AusPAR: Dapagliflozin". Therapeutic Goods Administration (TGA). 21 June 2022. Retrieved 20 April 2024.
  4. ^ "AusPAR: Dapagliflozin (as propanediol monohydrate)". Therapeutic Goods Administration (TGA). 21 June 2022. Retrieved 20 April 2024.
  5. ^ "Product monograph brand safety updates". Health Canada. 7 July 2016. Retrieved 1 April 2024.
  6. ^ a b c "Farxiga- dapagliflozin tablet, film coated". DailyMed. National Institutes of Health, National Library of Medicine, U.S. Department of Health & Human Services. 3 February 2020. Archived from the original on 30 October 2020. Retrieved 5 May 2020.
  7. ^ a b c d e f g h i j k l m n o p q r s "Forxiga EPAR". European Medicines Agency (EMA). Archived from the original on 17 February 2020. Retrieved 17 February 2020. Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
  8. ^ a b "Dapagliflozin Viatris EPAR". European Medicines Agency. 4 April 2023. Retrieved 17 June 2023. Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
  9. ^ "Edistride EPAR". European Medicines Agency (EMA). 9 November 2015. Retrieved 26 September 2024.
  10. ^ a b "Forxiga (dapagliflozin) 5mg should no longer be used for the treatment of Type 1 Diabetes Mellitus". European Medicines Agency (EMA). 11 November 2021. Archived from the original on 11 November 2021. Retrieved 11 November 2021.
  11. ^ a b c d e f g h i j k l "FDA approves new treatment for a type of heart failure". U.S. Food and Drug Administration (FDA) (Press release). 5 May 2020. Archived from the original on 6 May 2020. Retrieved 5 May 2020. Public Domain This article incorporates text from this source, which is in the public domain.
  12. ^ National Institute for Health and Care Excellence (24 February 2021). "Dapagliflozin for treating chronic heart failure with reduced ejection fraction". NICE Technology Appraisal Guidance [TA679]. NICE. Archived from the original on 9 May 2021. Retrieved 9 May 2021.
  13. ^ "BNF: Dapagliflozin". NICE. Retrieved 2 February 2024.
  14. ^ Ptaszynska A, Johnsson KM, Parikh SJ, de Bruin TW, Apanovitch AM, List JF (October 2014). "Safety profile of dapagliflozin for type 2 diabetes: pooled analysis of clinical studies for overall safety and rare events". Drug Safety. 37 (10): 815–829. doi:10.1007/s40264-014-0213-4. PMID 25096959. S2CID 24064402.
  15. ^ Dandona P, Mathieu C, Phillip M, Hansen L, Tschöpe D, Thorén F, et al. (DEPICT-1 Investigators) (December 2018). "Efficacy and Safety of Dapagliflozin in Patients With Inadequately Controlled Type 1 Diabetes: The DEPICT-1 52-Week Study". Diabetes Care. 41 (12): 2552–2559. doi:10.2337/dc18-1087. PMID 30352894. S2CID 53027785.
  16. ^ Hu Y, Bai Z, Tang Y, Liu R, Zhao B, Gong J, et al. (2020). "Fournier Gangrene Associated with Sodium-Glucose Cotransporter-2 Inhibitors: A Pharmacovigilance Study with Data from the U.S. FDA Adverse Event Reporting System". Journal of Diabetes Research. 2020: 3695101. doi:10.1155/2020/3695101. PMC 7368210. PMID 32695827.
  17. ^ World Health Organization (2023). The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization. hdl:10665/371090. WHO/MHP/HPS/EML/2023.02.
  18. ^ "The Top 300 of 2022". ClinCalc. Archived from the original on 30 August 2024. Retrieved 30 August 2024.
  19. ^ "Dapagliflozin Drug Usage Statistics, United States, 2013 - 2022". ClinCalc. Retrieved 30 August 2024.
  20. ^ "Generic Farxiga Availability". Drugs.com. 6 November 2024. Retrieved 30 November 2024.
  21. ^ The EMPA-KIDNEY Collaborative Group (12 January 2023). "Empagliflozin in Patients with Chronic Kidney Disease". New England Journal of Medicine. 388 (2): 117–127. doi:10.1056/NEJMoa2204233. ISSN 0028-4793. PMC 7614055. PMID 36331190.
  22. ^ a b c Heerspink HJ, Stefánsson BV, Correa-Rotter R, Chertow GM, Greene T, Hou FF, et al. (October 2020). "Dapagliflozin in Patients with Chronic Kidney Disease". The New England Journal of Medicine. 383 (15): 1436–1446. doi:10.1056/NEJMoa2024816. hdl:2445/189959. PMID 32970396. S2CID 221887260.
  23. ^ Perkovic V, Jardine MJ, Neal B, Bompoint S, Heerspink HJ, Charytan DM, et al. (June 2019). "Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy". The New England Journal of Medicine. 380 (24): 2295–2306. doi:10.1056/NEJMoa1811744. hdl:1805/22369. PMID 30990260. S2CID 117730201.
  24. ^ Baigent C, Emberson J, Haynes R, Herrington WG, Judge P, Landray MJ, et al. (Writing Committee, Smart-C Steering Committee) (November 2022). "Impact of diabetes on the effects of sodium glucose co-transporter-2 inhibitors on kidney outcomes: collaborative meta-analysis of large placebo-controlled trials". Lancet. 400 (10365): 1788–1801. doi:10.1016/S0140-6736(22)02074-8. PMC 7613836. PMID 36351458.
  25. ^ a b c McMurray JJ, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, et al. (November 2019). "Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction". The New England Journal of Medicine. 381 (21): 1995–2008. doi:10.1056/NEJMoa1911303. PMID 31535829. S2CID 202687033.
  26. ^ Packer M, Anker SD, Butler J, Filippatos G, Pocock SJ, Carson P, et al. (October 2020). "Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure" (PDF). The New England Journal of Medicine. 383 (15): 1413–1424. doi:10.1056/NEJMoa2022190. PMID 32865377. S2CID 221383070.
  27. ^ McGuire DK, Shih WJ, Cosentino F, Charbonnel B, Cherney DZ, Dagogo-Jack S, et al. (February 2021). "Association of SGLT2 Inhibitors With Cardiovascular and Kidney Outcomes in Patients With Type 2 Diabetes: A Meta-analysis". JAMA Cardiology. 6 (2): 148–158. doi:10.1001/jamacardio.2020.4511. PMC 7542529. PMID 33031522.
  28. ^ Bhattarai M, Salih M, Regmi M, Al-Akchar M, Deshpande R, Niaz Z, et al. (January 2022). "Association of Sodium-Glucose Cotransporter 2 Inhibitors With Cardiovascular Outcomes in Patients With Type 2 Diabetes and Other Risk Factors for Cardiovascular Disease: A Meta-analysis". JAMA Network Open. 5 (1): e2142078. doi:10.1001/jamanetworkopen.2021.42078. PMC 8733833. PMID 34985519.
  29. ^ Shi Z, Gao F, Liu W, He X (4 April 2022). "Comparative Efficacy of Dapagliflozin and Empagliflozin of a Fixed Dose in Heart Failure: A Network Meta-Analysis". Frontiers in Cardiovascular Medicine. 9: 869272. doi:10.3389/fcvm.2022.869272. PMC 9013819. PMID 35445086.
  30. ^ McGuire DK, Shih WJ, Cosentino F, Charbonnel B, Cherney DZ, Dagogo-Jack S, et al. (February 2021). "Association of SGLT2 Inhibitors With Cardiovascular and Kidney Outcomes in Patients With Type 2 Diabetes: A Meta-analysis". JAMA Cardiology. 6 (2): 148–158. doi:10.1001/jamacardio.2020.4511. PMC 7542529. PMID 33031522.
  31. ^ Zelniker TA, Wiviott SD, Raz I, Im K, Goodrich EL, Bonaca MP, et al. (January 2019). "SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials". Lancet. 393 (10166): 31–39. doi:10.1016/S0140-6736(18)32590-X. PMID 30424892. S2CID 53277899.
  32. ^ a b c d e f "Forxiga PI". Union Register of medicinal products. 14 November 2012. Retrieved 30 November 2024. Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
  33. ^ a b Cefalu WT, Leiter LA, de Bruin TW, Gause-Nilsson I, Sugg J, Parikh SJ (July 2015). "Dapagliflozin's Effects on Glycemia and Cardiovascular Risk Factors in High-Risk Patients With Type 2 Diabetes: A 24-Week, Multicenter, Randomized, Double-Blind, Placebo-Controlled Study With a 28-Week Extension". Diabetes Care. 38 (7): 1218–1227. doi:10.2337/dc14-0315. PMC 4831907. PMID 25852208.
  34. ^ a b Ferrannini E, Ramos SJ, Salsali A, Tang W, List JF (October 2010). "Dapagliflozin monotherapy in type 2 diabetic patients with inadequate glycemic control by diet and exercise: a randomized, double-blind, placebo-controlled, phase 3 trial". Diabetes Care. 33 (10): 2217–2224. doi:10.2337/dc10-0612. PMC 2945163. PMID 20566676.
  35. ^ a b Rossing P, Inzucchi SE, Vart P, Jongs N, Docherty KF, Jhund PS, et al. (January 2022). "Dapagliflozin and new-onset type 2 diabetes in patients with chronic kidney disease or heart failure: pooled analysis of the DAPA-CKD and DAPA-HF trials" (PDF). The Lancet. Diabetes & Endocrinology. 10 (1): 24–34. doi:10.1016/S2213-8587(21)00295-3. PMID 34856173. S2CID 244737266.
  36. ^ a b c d "FDA Approves Treatment for Chronic Kidney Disease" (Press release). U.S. Food and Drug Administration (FDA). 30 April 2021. Archived from the original on 30 April 2021. Retrieved 30 April 2021. Public Domain This article incorporates text from this source, which is in the public domain.
  37. ^ "Forxiga EPAR". European Medicines Agency (EMA). Archived from the original on 17 February 2020. Retrieved 17 February 2020.  This article incorporates copyrighted text that may be reproduced and/or distributed for non-commercial and commercial purposes, provided that the Agency is always acknowledged as the source of the material, from websites or documents of the European Medicines Agency.
  38. ^ Cherney DZ, Dekkers CC, Barbour SJ, Cattran D, Abdul Gafor AH, Greasley PJ, et al. (July 2020). "Effects of the SGLT2 inhibitor dapagliflozin on proteinuria in non-diabetic patients with chronic kidney disease (DIAMOND): a randomised, double-blind, crossover trial" (PDF). The Lancet. Diabetes & Endocrinology. 8 (7): 582–593. doi:10.1016/S2213-8587(20)30162-5. PMID 32559474. S2CID 219948034.
  39. ^ a b Yau K, Dharia A, Alrowiyti I, Cherney DZ (July 2022). "Prescribing SGLT2 Inhibitors in Patients With CKD: Expanding Indications and Practical Considerations". Kidney International Reports. 7 (7): 1463–1476. doi:10.1016/j.ekir.2022.04.094. PMC 9263228. PMID 35812300.
  40. ^ "FDA warns about rare occurrences of a serious infection of the genital area with SGLT2 inhibitors for diabetes". U.S. Food and Drug Administration (FDA). 9 February 2019. Archived from the original on 13 December 2019. Retrieved 16 December 2019. Public Domain This article incorporates text from this source, which is in the public domain.
  41. ^ "SGLT2 inhibitors: Drug Safety Communication - FDA Warns Medicines May Result in a Serious Condition of Too Much Acid in the Blood". U.S. Food and Drug Administration (FDA). 15 May 2015. Archived from the original on 27 October 2016. Retrieved 15 November 2016. Public Domain This article incorporates text from this source, which is in the public domain.
  42. ^ "Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes". New England Journal of Medicine. 380 (19): 1880–1882. 9 May 2019. doi:10.1056/NEJMc1902837. ISSN 0028-4793.
  43. ^ Liu J, Li L, Li S, Wang Y, Qin X, Deng K, et al. (September 2020). "Sodium-glucose co-transporter-2 inhibitors and the risk of diabetic ketoacidosis in patients with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials". Diabetes, Obesity & Metabolism. 22 (9): 1619–1627. doi:10.1111/dom.14075. PMID 32364674.
  44. ^ Phillip M, Mathieu C, Lind M, Araki E, di Bartolo P, Bergenstal R, et al. (February 2021). "Long-term efficacy and safety of dapagliflozin in patients with inadequately controlled type 1 diabetes: pooled 52-week outcomes from the DEPICT-1 and -2 studies". Diabetes, Obesity & Metabolism. 23 (2): 549–560. doi:10.1111/dom.14248. PMC 7839492. PMID 33145944.
  45. ^ a b "FDA revises labels of SGLT2 inhibitors for diabetes to include warning". U.S. Food and Drug Administration. 19 March 2020. Archived from the original on 7 June 2020. Retrieved 6 June 2020. Public Domain This article incorporates text from this source, which is in the public domain.
  46. ^ Kohan DE, Fioretto P, Tang W, List JF (April 2014). "Long-term study of patients with type 2 diabetes and moderate renal impairment shows that dapagliflozin reduces weight and blood pressure but does not improve glycemic control". Kidney International. 85 (4): 962–971. doi:10.1038/ki.2013.356. PMC 3973038. PMID 24067431.
  47. ^ US patent 6515117, Ellsworth B, Washburn WN, Sher PM, Wu G, Meng W, "C-aryl glucoside SGLT2 inhibitors and method", published 2003-02-04, assigned to AstraZeneca 
  48. ^ Sagandira CR, Khasipo AZ, Sagandira MB, Watts P (2021). "An overview of the synthetic routes to essential oral anti-diabetes drugs". Tetrahedron. 96: 132378. doi:10.1016/j.tet.2021.132378.
  49. ^ "Molecule of the Month: Clarivate". Prous Science. November 2007. Archived from the original on 5 November 2007.
  50. ^ Bailey CJ, Gross JL, Pieters A, Bastien A, List JF (June 2010). "Effect of dapagliflozin in patients with type 2 diabetes who have inadequate glycaemic control with metformin: a randomised, double-blind, placebo-controlled trial". Lancet. 375 (9733): 2223–2233. doi:10.1016/S0140-6736(10)60407-2. PMID 20609968. S2CID 9168659.
  51. ^ Bailey CJ, Gross JL, Hennicken D, Iqbal N, Mansfield TA, List JF (February 2013). "Dapagliflozin add-on to metformin in type 2 diabetes inadequately controlled with metformin: a randomized, double-blind, placebo-controlled 102-week trial". BMC Medicine. 11 (1): 43. doi:10.1186/1741-7015-11-43. PMC 3606470. PMID 23425012. S2CID 16429125.
  52. ^ Henry RR, Murray AV, Marmolejo MH, Hennicken D, Ptaszynska A, List JF (May 2012). "Dapagliflozin, metformin XR, or both: initial pharmacotherapy for type 2 diabetes, a randomised controlled trial". International Journal of Clinical Practice. 66 (5): 446–456. doi:10.1111/j.1742-1241.2012.02911.x. PMID 22413962. S2CID 9934488.
  53. ^ Lan NS, Fegan PG, Yeap BB, Dwivedi G (October 2019). "The effects of sodium-glucose cotransporter 2 inhibitors on left ventricular function: current evidence and future directions". ESC Heart Failure. 6 (5): 927–935. doi:10.1002/ehf2.12505. PMC 6816235. PMID 31400090.
  54. ^ Schubert-Zsilavecz M, Wurglics M (2008–2009). "Dapagliflozin". Neue Arzneimittel.
  55. ^ "International Nonproprietary Names for Pharmaceutical Substances (INN). Recommended International Nonproprietary Names: List 59" (PDF). World Health Organization. 2008. p. 50. Archived (PDF) from the original on 18 May 2016. Retrieved 15 November 2016.
  56. ^ "Statement on a Nonproprietary Name Adopted by the USAN Council" (PDF). American Medical Association. Archived from the original (PDF) on 7 February 2012. Retrieved 15 November 2016.
  57. ^ "US FDA Approves Once-Daily Xigduo XR Tablets for Adults with Type 2 Diabetes". AstraZeneca. 30 October 2014. Archived from the original on 16 November 2016. Retrieved 15 November 2016.
  58. ^ "Drug Approval Package: Xigduo XR (dapagliflozin and metformin HCl) Extended-Release Tablets". U.S. Food and Drug Administration (FDA). 7 April 2015. Archived from the original on 20 February 2020. Retrieved 5 May 2020.
  59. ^ "Xigduo XR- dapagliflozin and metformin hydrochloride tablet, film-coated, extended-release". DailyMed. 3 February 2020. Archived from the original on 2 March 2021. Retrieved 5 May 2020.
  60. ^ "Qtern EPAR". European Medicines Agency (EMA). Archived from the original on 14 July 2020. Retrieved 7 May 2020.
  61. ^ "Drug Approval Package: Qtern (dapagliflozin and saxagliptin)". U.S. Food and Drug Administration (FDA). 10 October 2018. Archived from the original on 14 July 2020. Retrieved 8 May 2020.
  62. ^ "Qtern- dapagliflozin and saxagliptin tablet, film coated". DailyMed. 24 January 2020. Archived from the original on 14 July 2020. Retrieved 17 February 2020.
  63. ^ "Drug Approval Package: Qternmet XR". U.S. Food and Drug Administration (FDA). 27 January 2020. Archived from the original on 17 February 2020. Retrieved 17 February 2020.
  64. ^ "Qtrilmet EPAR". European Medicines Agency (EMA). 16 September 2019. Archived from the original on 29 December 2019. Retrieved 30 March 2020.
  65. ^ "Forxiga". Drugs.com. 4 May 2020. Archived from the original on 28 August 2021. Retrieved 5 May 2020.
  66. ^ "Drug Approval Package: Farxiga (dapagliflozin) Tablets NDA #202293". U.S. Food and Drug Administration (FDA). 24 December 1999. Archived from the original on 19 September 2020. Retrieved 5 May 2020.
  67. ^ Kato ET, Silverman MG, Mosenzon O, Zelniker TA, Cahn A, Furtado RH, et al. (May 2019). "Effect of Dapagliflozin on Heart Failure and Mortality in Type 2 Diabetes Mellitus". Circulation. 139 (22): 2528–2536. doi:10.1161/CIRCULATIONAHA.119.040130. PMID 30882238. S2CID 81977866.
  68. ^ "FARXIGA Granted Fast Track Designation in the US for Heart Failure Following Acute Myocardial Infarction Leveraging an Innovative Registry-Based Trial Design" (Press release). AstraZeneca. 16 July 2020. Archived from the original on 20 July 2020. Retrieved 20 July 2020 – via Business Wire.
  69. ^ "FARXIGA Demonstrated Unprecedented Reduction in the Risk of Kidney Failure and Cardiovascular or Renal Death in Patients with Chronic Kidney Disease in the Phase III DAPA-CKD Trial" (Press release). AstraZeneca. 30 August 2020. Archived from the original on 31 August 2020. Retrieved 4 September 2020 – via Business Wire.
  70. ^ "Forxiga approved in EU for chronic heart failure". European Pharmaceutical Review. Retrieved 9 February 2023.
  71. ^ "Dapagliflozin Gets Expanded Heart Failure Indication in Europe". Medscape. Retrieved 9 February 2023.
  72. ^ "Drugs@FDA: Dapagliflozin". U.S. Food and Drug Administration (FDA). Archived from the original on 25 March 2022. Retrieved 25 March 2022.
  73. ^ Rudge D (24 February 2022). "Patent Blocks Zydus After Landmark US Approval For Dapagliflozin". Archived from the original on 10 June 2022. Retrieved 8 June 2022.
  74. ^ "Dapagliflozin – USA". 15 October 2021. Archived from the original on 10 June 2022. Retrieved 8 June 2022.
  75. ^ "JAMP Pharma Group receives Health Canada approval for PrJAMP Dapagliflozin, a new generic alternative for the treatment of type 2 diabetes" (Press release). JAMP Pharma. 16 May 2023. Retrieved 17 June 2023 – via Newswire.
  76. ^ "Dapagliflozin Viatris: Pending EC decision". European Medicines Agency. 26 January 2023. Archived from the original on 27 January 2023. Retrieved 29 January 2023. Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.
  77. ^ Zhai M, Du X, Liu C, Xu H (30 June 2021). "The Effects of Dapagliflozin in Patients With Heart Failure Complicated With Type 2 Diabetes: A Meta-Analysis of Placebo-Controlled Randomized Trials". Frontiers in Clinical Diabetes and Healthcare. 2: 703937. doi:10.3389/fcdhc.2021.703937. PMC 10012068. PMID 36994345.
Retrieved from "https://en.wikipedia.org/w/index.php?title=Dapagliflozin&oldid=1260340373"