Invokamet Approved as a First-Line Therapy for Type 2 Diabetes

Patients with high A1c levels could achieve greater blood glucose control from the start.

Janssen recently announced that the FDA has approved the combination-drug Invokamet (Invokana + metformin) for use as a first-line treatment for adults with type 2 diabetes. While Invokamet was originally approved in August of 2014, this new approval means that physicians can now prescribe a single pill with metformin and Invokana (canagliflozin) as the first drug for those newly diagnosed with type 2 diabetes. Previously, Invokamet was only approved for use in people who did not achieve their glucose targets after another drug (typically metformin) has already been taken alone, or people who were taking both medications separately – see our appendix below to learn more.

Invokamet’s expanded approval brings several benefits for people with type 2 diabetes:

• People with higher A1c levels can achieve greater blood glucose control right from the start. Combining metformin and Invokana - two effective, complementary medicines – can help lower A1c more than either drug alone. Invokamet may help patients with higher A1c levels more successfully achieve their goals.

• The convenience of a 2-in-1 medication. Combining two medications in one pill increases convenience for patients who may be able to reduce the number of pills they take each day. Additionally, it can potentially reduce side effects compared with taking multiple drugs separately, and has potential to decrease co-pays for multiple medications.

• More dosing options. Invokamet is available in four dose strengths, in tablets containing canagliflozin 50 milligrams (mg) or 150 mg, and metformin in 500 mg or 1000 mg doses. Now that physicians can prescribe Invokamet as a first-line drug and have four dosing options, patients can receive tailored therapy for their individual needs.

Who Might Use Invokamet?

According to recent type 2 diabetes treatment guidelines, combination drugs are recommended for the following three groups of type 2 patients:

• people with an A1c of 7.5% or higher at diagnosis

• people who have an A1c below 7.5% at diagnosis, but do not achieve a target A1c goal (<7%) after about three months on a single therapy (often metformin)

• as a first line therapy for people with an A1c level above 9% at diagnosis, without any additional symptoms

Side effects with Invokamet include yeast and other genital infections, as well as increased urination. Moreover, the FDA recently announced a safety warning for Invokana and Invokamet based on early clinical trial data that the drugs may possibly cause increased risk of lower limb amputations (read more here). We always recommend speaking with your healthcare team before making any changes to a treatment plan.

Appendix: What is Invokamet?

Invokamet is a fixed-dose combination-drug, combining the drugs metformin and Invokana into a single, twice-daily pill. Metformin is generally the first drug prescribed to people when they are diagnosed with type 2 diabetes, and works to decrease glucose production from the liver and improve the body’s response to insulin. Invokana is an SGLT-2 inhibitor, which blocks the reabsorption of glucose in the kidney. Basically, that means that people with diabetes who take this drug are peeing out extra glucose. SGLT-2 inhibitors only work when glucose levels are high and stop working when they are low (this is called “glucose dependent”). In addition to A1c reduction, SGLT-2 inhibitors often cause weight loss, reductions in blood pressure, and come with less risk of hypoglycemia than insulin. -CA