Bexagliflozin: pharmacological profile and clinical applications of a sodium-glucose cotransporter 2 inhibitor

Abstract

Bexagliflozin, approved in the United States in 2023, is the fifth selective sodium-glucose cotransporter 2 (SGLT2) inhibitor for type 2 diabetes mellitus (T2DM). Unlike other class members, it lacks an event-driven cardiovascular outcomes trial (CVOT) and trials with hard kidney or heart failure endpoints. This narrative mini-review separates bexagliflozin-specific evidence from class benefits. PubMed and Google Scholar were searched for English-language articles (January 2009–June 2026) using “bexagliflozin,” “Brenzavvy,” and “SGLT2 inhibitor,” plus prescribing information and pivotal class trials. Randomized trials and meta-analyses were prioritized. Bexagliflozin reduced glycated hemoglobin (HbA _1c ), body weight, and systolic blood pressure vs. placebo and was noninferior to sitagliptin, glimepiride, and, in one 24-week trial, dapagliflozin for HbA _1c . In stage 3a/3b chronic kidney disease, it reduced albuminuria by 20.1 % vs. placebo, a surrogate finding. A cardiovascular safety trial and meta-analysis excluded excess cardiovascular risk but were not powered for benefit. Adverse events were consistent with the class. Bexagliflozin is an effective glucose-lowering drug, but its cardiovascular, kidney, and heart failure benefits remain unproven and cannot be assumed from class data. Outcome-proven agents are preferred for cardiorenal protection. An adequately powered CVOT and hard kidney endpoint trials are the key research priorities.