NICE recommends three SGLT-2 inhibitors for type 2 diabetes
Three new SGLT-2 inhibitors have received final NICE approval in type 2 diabetes. Canagliflozin (Invokana™), dapagliflozin (Forxiga™) and empagliflozin (Jardiance™) are now available to patients with type 2 diabetes who cannot tolerate metformin, sulfonylurea or pioglitazone therapy and are not being controlled with diet and exercise. NICE estimates that over 30,000 patients may be eligible for these drugs and the cost of a year’s treatment with each drug is approximately £475.
SGLT-2 inhibitors block the reabsorption of glucose in the kidney, increase glucose excretion, and lower blood glucose levels. All three drugs have UK marketing authorisations for treating type 2 diabetes to improve glycaemic control in adults:
- as monotherapy: when diet and exercise alone do not provide adequate glycaemic control in people for whom the use of metformin is considered inappropriate due to intolerance or contraindications
- as add‑on combination therapy: with other glucose–lowering medicinal products including insulin, when these, together with diet and exercise, do not provide adequate glycaemic control.
Recent data on empagliflozin which showed reductions in cardiovascular risk has further boosted confidence in this newer class of anti-diabetes drugs.
The SGLT-2 inhibitors now provide an alternative to the DPP-4 inhibitors and Professor Carole Longson, director of the NICE Centre for Health Technology Evaluation said, “The committee agreed that people with diabetes and their clinicians would value having an additional treatment option to help manage their type 2 diabetes – which this positive guidance provides.”
Diabetes UK was also positive about these new development with Director of Health Intelligence and Professional Liaison Simon O’Neill commenting, “We welcome the new guidance on using the SGLT-2 group of type 2 diabetes medications as a monotherapy. This gives people with type 2 diabetes and their healthcare team more options when metformin is not appropriate. We know that different people with type 2 diabetes may respond favourably to different medications. So this guidance offers more choice for clinicians to individualise the care they provide, which can have a significant impact on the quality of life of some people with type 2 diabetes.”
Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes. NICE technology appraisal guidance [TA390] Published date: 25 May 2016.