Invokana’s (JNJ, Daiichi, Mitsubishi) CANVAS program, presented at the 2017 American Diabetes Association Scientific Sessions, confirmed a CV benefit for the SGLT-2 inhibitor class seen with Jardiance (Boehringer, LLY) in EMPA-REG. However, the benefit on CV death in CANVAS was numerically substantially smaller, and there was an increased risk of amputations. To gauge the views of primary care physicians (PCPs), Biomedtracker/Datamonitor Healthcare conducted a nine-question survey of 38 PCPs in the US -- 21 of whom are currently low users of SGLT- 2 inhibitors, and to gauge the sentiment of those currently favoring Invokana, another 17 predominant Invokana users. The survey also evaluates attitudes towards Victoza’s LEADER trial. Survey questions and additional resources are listed further below. If you are a KOL Insight Subscriber, please access the survey from our KOL Insight portal (Subscribers only). Biomedtracker will be offering KOL Reports and Physician Pulse Surveys for purchase a la carte, or access to all reports and surveys can be purchased as a subscription to KOL Insight. For more information on KOL Insight subscription, please email Biomedtracker or call Biomedtracker Client Services at (858) 200-2357. For our disclosures, please read the Biomedtracker Research Standards. Survey Questions:

• Screening question (part 1): To what percentage of your type 2 diabetes patients on diabetic medications do you currently prescribe SGLT-2 inhibitors?
• Screening question (part 2): Which of these SGLT-2 inhibitors do you use the most?
• Screening question (parts 1 and 2): Are you familiar with the results from Invokana's CANVAS cardiovascular outcomes trial in type 2 diabetes?
• Please provide your best estimate for the percentage of your type 2 diabetes patients on diabetic medications that are covered by Medicare, Medicaid, or private insurance.
• To what extent are your choices of non-insulin antidiabetics dependent on particular insurance plans?
• To what percentage of your type 2 diabetes patients on diabetic medications do you currently prescribe each of the following treatment regimens?
• In CANVAS, Invokana lowered the MACE primary endpoint (CV death, MI, stroke) similar to what Jardiance did in EMPA-REG (-16% for both), but the reduction in individual components differed substantially between the two drugs. Please see the table below for the results. Please indicate which of the below most closely represents your view of these trials.
• Do you consider analyses looking at individual MACE components to be reliable?
• In the LEADER CVOT, the GLP-1 agonist Victoza lowered the MACE primary endpoint (CV death, MI, stroke) similar to what the SGLT- 2 inhibitors did in their CVOTs, but again, there were differences in the components of MACE. The results are in the table below. Please indicate how impressive you find the CV benefits of each of the below drugs.
• In CANVAS, Invokana increased lower limb amputations compared to placebo (6.3 vs 3.4 per 1,000 patient years, p<0.05), but 95% were in patients with a prior amputation and 71% were minor amputations (toe or transmetatarsal). In EMPA-REG, there was no difference in amputations for Jardiance versus placebo. Comparing the trials, the rate of amputations for Jardiance was similar to Invokana, but the placebo rate in EMPA-REG was higher than in CANVAS. Please choose the best answers for each row.
• Assume that Invokana and Victoza will soon have label indications for reducing cardiovascular events (MACE) in diabetics with CV disease, and Jardiance still has its label indication for reducing CV death in diabetics with CV disease. To which patient segment would you ideally prescribe the following drugs?
• Assume again that Invokana and Victoza will soon have label indications for reducing cardiovascular events in diabetics with CV disease, and Jardiance still has its label indication for reducing CV death in diabetics with CV disease. In three years, to what percentage of your type 2 diabetes patients on diabetic medications will you prescribe the following treatments?