Dr. Ahmed On 20th January, the FDA approved a new SGLT2 inhibitor, Bexagliflozin for the treatment of adults with Type 2 Diabetes [Ref].
The drug is a brand of TheracosBio by the name of Brenzavvy.
Bexagliflozin is the 5th SGLT2 inhibitor that the FDA approved for the treatment of adults with Type 2 Diabetes. The other SGLT2 inhibitors that have been approved and are very commonly used are:
Bexagliflozin was approved in December 2022 for the treatment of Diabetes in cats.
How effective is Brenzavvy Vs other SGLT2 Inhibitors?
According to the ADA 2023 guidelines, SGLT2 inhibitors are classified as “intermediate to highly potent” diabetes medicines.
The following table summarizes diabetes drugs based on their potency:
Efficacy of Type 2 Diabetes Medications (in descending order) | Class | Examples |
| Intermediate | DPP-IV Inhibitors |
|
| Intermediate to high | SGLT2 Inhibitors |
|
| High | Metformin |
|
| Thiazolidinediones |
| |
| 2nd Generation Sulfonylureas |
| |
| High to very highly effective | GLP-1 Receptor agonists |
|
| Insulin |
| |
| Very high potency | GIP and GLP-1 Receptor agonists |
|
Among the SGLT2 inhibitors, Canagliflozin is the most potent, followed by Ertugliflozin, Empagliflozin, and Dapagliflozin.
The A1C reduction of different SGLT2 inhibitors is tabulated below:
SGLT2 Inhibitor | Dose | Percentage A1C reduction |
| Canagliflozin | 100 mg | ↓ 0.91% |
| 300 mg | ↓ 1.16% | |
| Empagliflozin | 10 mg | ↓ 0.7% |
| 25 mg | ↓ 0.8% | |
| Ertugliflozin | 5 mg | ↓0.6% |
| 15 mg | ↓ 0.7% | |
| Dapagliflozin | 5 mg | ↓0.6% |
| 10 mg | ↓ 0.7% | |
| Bexagliflozin | 20 mg | ↓ 0.5% |
SGLT2 inhibitors are categorized based on their potency (Data is taken from the FDA-prescribing information of each drug):
SGLT2 Inhibitor | Dose | Percentage A1C reduction |
| Canagliflozin | 300 mg | ↓ 1.16% |
| Canagliflozin | 100 mg | ↓ 0.9% |
| Empagliflozin | 25 mg | ↓ 0.8% |
| Empagliflozin | 10 mg | ↓ 0.7% |
| Ertugliflozin | 15 mg | ↓ 0.7% |
| Dapagliflozin | 10 mg | ↓ 0.7% |
| Ertugliflozin | 5 mg | ↓ 0.6% |
| Dapagliflozin | 5 mg | ↓ 0.6% |
| Bexagliflozin | 20 mg | ↓ 0.5% |
Since Bexagliflozin (Brenzavvy) is one of the least potent SGLT2 inhibitors, it might not be able to compete with other SGLT2 inhibitors.
In addition, Bexagliflozin (Brenzavvy) is contraindicated in patients with kidney disease and not recommended in patients with a CrCl of less than 30 ml/minute.
Thus, although approved by the FDA for the treatment of diabetes, it may not win the markets.
Additional studies may be needed to see the full therapeutic response of the drug.
Lastly, if the price is kept the lowest, it may be utilized by physicians for their patients who are paying from their pockets or in low-income countries.
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