Canagliflozin, dapagliflozin and empagliflozin monotherapy for treating type 2 diabetes: systematic review and economic evaluation

Autor: Norman Waugh, Ewen Cummins, Saran Shantikumar, Jill L Colquitt, Andrew Clegg, J. Paul O'Hare, P Royle, Tim Holt, Olalekan A. Uthman, Christine Clar, Rachel Court, R Johnston, Bee K. Tan, David McGrane
Rok vydání: 2017
Předmět:
Blood Glucose
medicine.medical_specialty
lcsh:Medical technology
Cost-Benefit Analysis
Blood Pressure
030209 endocrinology & metabolism
Type 2 diabetes
Placebo
Body Mass Index
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Glucosides
Weight loss
Internal medicine
medicine
Empagliflozin
Humans
Hypoglycemic Agents
030212 general & internal medicine
Benzhydryl Compounds
Canagliflozin
Dapagliflozin
Adverse effect
Sodium-Glucose Transporter 2 Inhibitors
Randomized Controlled Trials as Topic
Glycated Hemoglobin
Dose-Response Relationship
Drug
business.industry
Health Policy
B890
medicine.disease
Metformin
Diabetes Mellitus
Type 2
lcsh:R855-855.5
chemistry
Quality of Life
Quality-Adjusted Life Years
medicine.symptom
business
Models
Econometric
RC
Research Article
medicine.drug
Zdroj: Health Technology Assessment, Vol 21, Iss 2 (2017)
ISSN: 2046-4924
1366-5278
DOI: 10.3310/hta21020
Popis: Background Most people with type 2 diabetes are overweight, so initial treatment is aimed at reducing weight and increasing physical activity. Even modest weight loss can improve control of blood glucose. If drug treatment is necessary, the drug of first choice is metformin. However, some people cannot tolerate metformin, which causes diarrhoea in about 10%, and it cannot be used in people with renal impairment. This review appraises three of the newest class of drugs for monotherapy when metformin cannot be used, the sodium–glucose co-transporter 2 (SGLT2) inhibitors. Objective To review the clinical effectiveness and cost-effectiveness of dapagliflozin (Farxiga, Bristol-Myers Squibb, Luton, UK), canagliflozin (Invokana, Janssen, High Wycombe, UK) and empagliflozin (Jardiance, Boehringer Ingelheim, Ingelheim, Germany/Eli Lilly and Company, Indianapolis, IN, USA), in monotherapy in people who cannot take metformin. Sources MEDLINE (1946 to February 2015) and EMBASE (1974 to February 2015) for randomised controlled trials lasting 24 weeks or more. For adverse events, a wider range of studies was used. Three manufacturers provided submissions. Methods Systematic review and economic evaluation. A network meta-analysis was carried out involving the three SGLT2 inhibitors and key comparators. Critical appraisal of submissions from three manufacturers. Results We included three trials of dapagliflozin and two each for canagliflozin and empagliflozin. The trials were of good quality. The canagliflozin and dapagliflozin trials compared them with placebo, but the two empagliflozin trials included active comparators. All three drugs were shown to be effective in improving glycaemic control, promoting weight loss and lowering blood pressure (BP). Limitations There were no head-to-head trials of the different flozins, and no long-term data on cardiovascular outcomes in this group of patients. Most trials were against placebo. The trials were done in patient groups that were not always comparable, for example in baseline glycated haemoglobin or body mass index. Data on elderly patients were lacking. Conclusions Dapagliflozin, canagliflozin and empagliflozin are effective in improving glycaemic control, with added benefits of some reductions in BP and weight. Adverse effects are urinary and genital tract infections in a small proportion of users. In monotherapy, the three drugs do not appear cost-effective compared with gliclazide or pioglitazone, but may be competitive against sitagliptin (Januvia, Merck Sharp & Dohme Limited, Kenilworth, NJ, USA). Funding The National Institute for Health Research Health Technology Assessment programme.
Databáze: OpenAIRE
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