The National Institute of Health and Care Excellence (NICE) has recommended that SGLT-2 inhibitors on the UK market can be used earlier in patients with diabetes. The new guidance allows the drugs to be used first-line for people who cannot tolerate metformin, and in whom sulfonylureas or Actos (pioglitazone) are not considered appropriate. More importantly, the recommendations put the SGLT-2 inhibitors on par with another newer class of diabetes drug — DPP-4 inhibitors such as MSD’s Januvia (sitagliptin) and AstraZeneca’s Onglyza (saxagliptin). The guidance applies to Johnson & Johnson’s Invokana (canagliflozin), AstraZeneca’s Farxiga (dapagliflozin) and Boehringer Ingelheim/Eli Lilly’s Jardiance (empagliflozin).
Previously, NICE guidance only backed use of the drugs in combination with metformin, either alone or in combination with a sulfonylurea or insulin, but now the recommendations allow clinicians “the freedom to prescribe SGLT-2 inhibitors when they feel it is appropriate.” While the growth of the SGLT-2 inhibitor class has been held back somewhat by safety concerns such as ketoacidosis, data published last year on Jardiance showing it was able to lower cardiovascular risk — the first diabetes drug to do so — has reinforced confidence in the class. — Recommendation positions Invokana, Farxiga and Jardiance as first-line treatments