New study provides further evidence for efficacy and safety of SGLT2 inhibitor velagliflozin in diabetic cats
29 July 2024
Last year, Senvelgo (velagliflozin) – a once daily oral solution for the treatment of feline diabetes – was licenced in the UK, with much excitement over how it could overcome some of the challenges in managing diabetic cats and revolutionise the treatment of feline diabetes mellitus.
Current treatment options for diabetes mellitus in cats are limited to insulin injections and monitoring for hypoglycemia, which has a psychosocial burden on cat owners1. It has been estimated that as many as 3 in 10 diabetic cats are euthanised during the first year after diagnosis, with cost and impact on owner’s lifestyle being important motivating factors2.
A new randomised controlled study published in the Journal of Veterinary Internal Medicine1 has compared the efficacy and safety of once daily oral administration of velagliflozin with twice daily insulin injections in diabetic cats.
127 diabetic cats were enrolled and randomised to receive either oral velagliflozin (1 mg/kg, given with or without feeding, 24 hours apart; 54 cats) or Caninsulin injection (dose adjusted by clinician based on clinical signs and the results of blood glucose curves and serum fructosamine, given with food, 12 hours apart; 62 cats) for an efficacy phase of 45 days. Primary treatment efficacy was compared on day 45 and defined as the number of cats with treatment success in at least one clinical variable (polyuria, polydipsia, polyphagia, plantigrade/palmigrade stance) and at least one glycemic variable (average blood glucose (BG), minimum BG of blood glucose curves (BGC), serum fructosamine). Secondary efficacy endpoints were assessed for 91 days. All potential adverse health effects were recorded by attending clinicians.
What did the study find?
On day 45, 54% of velagliflozin-treated cats and 42% of Caninsulin-treated cats showed treatment success, demonstrating that velagliflozin was noninferior to Caninsulin treatment.
Polyuria improved in 54% and polydipsia in 61% of velagliflozin cats. Mean BG of the BGC was ≤14 mmol/L in 82% of the velagliflozin group and in 45% of the insulin group; minimum BG of the BGC was ≤9 mmol/L in 74% of the velagliflozin group and in 52% of the insulin group; and serum fructosamine was ≤450 μmol/L in 72% of the velagliflozin group and 44% of the insulin group. Diabetic ketoacidosis occurred in 7% of velagliflozin cats and in no insulin cats. Improvements in quality of life were reported with both treatments; in 81% of velagliflozin cats and 74% of insulin cats.
Adverse events (AE) were experienced in 85% of velagliflozin cats and 89% of insulin cats. The most frequent AEs reported in velagliflozin cats were loose feces/diarrhoea (38%), clinician-reported clinical cystitis/urinary tract infection (21%) and nonclinical hypoglycemia (13%), and in insulin cats were hypoglycemia (53%) – clinical (8%) and nonclinical (52%), clinician-reported clinical cystitis/urinary tract infection (15%), and loose feces/diarrhoea (15%). Overall, 7% of velagliflozin cats (4 out of 61) and 8% of insulin cats (5 out of 66) were euthanised during the study.
Take home message
Daily oral administration of velagliflozin is safe and effective as a stand-alone treatment in naïve and pretreated diabetic cats, resulting in improvement of many clinical signs (some within a week), owner-reported quality of life and a rapid effect on glycemic variables in most cats, and no records of clinical hypoglycemia. Velagliflozin provides a treatment option to simplify current management strategies for diabetic cats, although further studies would be worthwhile, for example, on the exact effect on consumed water and volume of urination and how to mitigate any possible risk for euglycemic DKA.
Read the full study: https://onlinelibrary.wiley.com/doi/full/10.1111/jvim.17124.
References
1 Niessen SJM, Kooistra HS, Forcada Y, et al. (2024) Efficacy and safety of once daily oral administration of sodium-glucose cotransporter-2 inhibitor velagliflozin compared with twice daily insulin injection in diabetic cats. J Vet Intern Med. 1-21. doi:10.1111/jvim.17124
2Niessen SJM, Hazuchova K, Powney SL, et al. (2017) The Big Pet Diabetes Survey: Perceived Frequency and Triggers for Euthanasia. Veterinary Sciences. 4(2):27. doi.org/10.3390/vetsci4020027