Canagliflozin and Renal Outcomes in Diabetic Nephropathy

To the Editor: The CREDENCE (Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation) trial reported by Perkovic et al. (June 13 issue) 1 exemplifies a deficiency in the pharmaceutical regulatory system — that is, sponsors are not required to ascertain whether the results of canagliflozin therapy and those of more cost-effective diuretic therapy might be similar. In this trial, canagliflozin, a drug with diuretic properties, was administered to patients with diabetic kidney disease, nearly all of whom were receiving a renin–angiotensin–aldosterone system (RAAS) inhibitor. In the placebo group, however, fewer than half the patients were taking diuretics. In . . .