A Review of the Safety and Efficacy of Bexagliflozin for the Management of Type 2 Diabetes

Objective: To review the pharmacology of bexagliflozin in addition to its safety and efficacy from available clinical trials used for its approval, as well as available clinical evidence to date. Data Sources: A search of the National Institutes of Health Clinical Trials Registry ( http://www.clinicaltrials.gov ) and PubMed database was performed from inception through June 1, 2023. Study Selection and Data Extraction Quantification: The following study designs were included: meta-analyses, systematic review, clinical trial, or observational study design. Abstracts and drug monographs were also reviewed. Narrative or scoping reviews were excluded. Only articles in the English language and those evaluating the pharmacology, pharmacokinetics, safety, or efficacy of bexaglifozin in humans were included. Data Synthesis: Bexagliflozin reduces hemoglobin A1c ~0.5% with similar reductions in systolic blood pressure and body weight to other SGLT2 inhibitors. No cardiovascular outcomes trial is published, nor ongoing at this time. Adverse effects are similar to other SGLT2 inhibitors (genital mycotic and urinary tract infections, increased urination) including a warning for lower extremity amputation similar to canagliflozin. Relevance to Patient Care and Clinical Practice in Comparison to Existing Drugs: Although no cost-effectiveness data are available, statements from the manufacturer suggest a competitive price point. Given limited trial data, lower cost, if chosen, may create a temporary niche for bexagliflozin pending generic availability of other SGLT2 inhibitors. However, given lack of cardiovascular and renal outcome data, empagliflozin, dapagliflozin, or canagliflozin may be preferred. Conclusion: Bexagliflozin appears safe and effective as monotherapy and add-on pharmacological therapy for the treatment of T2D.