A new SGLT2i is now on the market, promoting a new option for diabetes management. Bexagliflozin (Brenzavvy) got FDA approval in January of this year adding it to the list of SGLT2 inhibitors. With a few already on the scene, it bears the question, is bexagliflozin going to bring something special to the table? In this article, we’ll provide the details in comparing bexagliflozin to the other SGLT2 inhibitors on the market.
Looking over data from previous studies surrounding other SGLT2i on the market it is unclear where Bexagliflozin will fit in. Out of its market competitors, it has the smallest A1c lowering (around -0.4%), which also translates to being the lowest in fasting plasma glucose lowering. It does find itself having a middle-of-the-road in systolic blood pressure lowering (-3.8mmHg), however, no studies are present yet for cardiovascular protective indications (definitely something to be aware of for board certification exams!). The only notable advantage is that there aren’t dose adjustments. Everyone will receive 20 mg daily with no titration necessary. This is unique when comparing bexagliflozin to the other SGLT2 inhibitors.
The newest study showed that Bexagliflozin is safe and effective for those with Class 3A/3B chronic kidney disease. This gives it a leg up on Ertugliflozin which is contraindicated with eGFR <45 mL/min. Dapagliflozin is not recommended with a GFR <45 mL/min (for diabetes), however, it is frequently used down to 25 mL/min for other indications. Canagliflozin and Empagliflozin can be used down to 30 mL/min but require dosing adjustments.
Looking into other advantages of this medication, there is little information surrounding its availability and pricing. As the medication is on the market longer more information will be available, however, most others in the class come with a hefty price tag, so Bexagliflozin is probably in the same boat.
So down to brass tacks. Is an SGLT2i with no dose adjustments for renal impairment worth the hype? Bexagliflozin has shown no cardiovascular benefit and isn’t indicated for heart failure. Bexagliflozin also had the lowest A1c lowering out of the competitors on the market. The studies also bore out that there may be a slight risk of lower limb amputation. This may or may not hold. A black box warning was on Canagliflozin but has since been removed. So while it is always nice to have another option for diabetic control, I would hold off on calling bexagliflozin a game-changer.
What do you think? Did we miss anything when comparing bexagliflozin to the other SGLT2 inhibitors?
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