Costs and Consequences Associated With Newer Medications for Glycemic Control in Type 2 Diabetes

Sinha, Anushua; Rajan, Mangala; Hoerger, Thomas J.; Pogach, Len

doi:10.2337/dc09-1488

Cited by 54 publications

(55 citation statements)

References 32 publications

(32 reference statements)

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“…DPP-4 inhibitors are clearly more expensive than SUs, but less expensive than GLP-1 receptor agonists [98]. This means that demonstrable gains in quality of life and/or longevity with these new agents are necessary to prove their economic value to both patients and healthcare systems [99]. Although there are favourable cost-effectiveness and cost-utility data for DPP-4 inhibitors compared with SUs, only scanty preliminary data are currently available [100].…”

Section: Pharmacoeconomic Evaluationmentioning

confidence: 99%

DPP-4 inhibitors in the management of type 2 diabetes: A critical review of head-to-head trials

Scheen¹

2012

Diabetes & Metabolism

174

124

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Dipeptidyl peptidase-4 (DPP-4) inhibitors offer new options for the management of type 2 diabetes. Direct comparisons with active glucose-lowering comparators in drug-naive patients have demonstrated that DPP-4 inhibitors exert slightly less pronounced HbA 1c reduction than metformin (with the advantage of better gastrointestinal tolerability) and similar glucose-lowering effects as with a thiazolidinedione (TZD; with the advantage of no weight gain). In metformin-treated patients, gliptins were associated with similar HbA 1c reductions compared with a sulphonylurea (SU; with the advantage of no weight gain, considerably fewer hypoglycaemic episodes and no need for titration) and a TZD (with the advantage of no weight gain and better overall tolerability). DPP-4 inhibitors also exert clinically relevant glucose-lowering effects compared with a placebo in patients treated with SU or TZD (of potential interest when metformin is either not tolerated or contraindicated), and as oral triple therapy with a good tolerability profile when added to a metformin-SU or pioglitazone-SU combination. Several clinical trials also showed a consistent reduction in HbA 1c when DPP-4 inhibitors were added to basal insulin therapy, with no increased risk of hypoglycaemia. Because of the complex pathophysiology of type 2 diabetes and the complementary actions of glucose-lowering agents, initial combination of a DPP-4 inhibitor with either metformin or a glitazone may be applied in drug-naive patients, resulting in greater efficacy and similar safety compared with either drug as monotherapy. However, DPP-4 inhibitors were less effective than GLP-1 receptor agonists for reducing HbA 1c and body weight, but offer the advantage of being easier to use (oral instead of injected administration) and lower in cost. Only one head-tohead trial demonstrated the non-inferiority of saxagliptin vs sitagliptin. Clearly, more trials of direct comparisons between different incretin-based therapies are needed. Because of their pharmacokinetic characteristics, pharmacodynamic properties (glucose-dependent glucose-lowering effect) and good overall tolerability profile, DPP-4 inhibitors may have a key role to play in patients with renal impairment and in the elderly. The role of DPP-4 inhibitors in the therapeutic armamentarium of type 2 diabetes is rapidly evolving as their potential strengths and weaknesses become better defined mainly through controlled clinical trials. Keywords:Clinical trial-DPP-4 inhibitor; Alogliptin; Linagliptin; Saxagliptin; Sitagliptin; Vildagliptin; Type 2 diabetes mellitus; Review Résumé Les inhibiteurs de la DPP-4 dans le traitement du diabète de type 2 : revue critique des essais cliniques contrôlés.Les inhibiteurs de la dipeptidylpeptidase-4 (DPP-4) offrent de nouvelles options pour le traitement du diabète de type 2. Des comparaisons directes avec d'autres médicaments antidiabétiques chez des patients naïfs de tout traitement ont démontré que les inhibiteurs de la DPP-4 étaient un peu moins puissants pour diminuer ...

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Section: Pharmacoeconomic Evaluationmentioning

confidence: 99%

DPP-4 inhibitors in the management of type 2 diabetes: A critical review of head-to-head trials

Scheen¹

2012

Diabetes & Metabolism

174

124

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“…5,6 These NICE guidelines are influenced by the cost of GLP-1ra treatment which is much higher than other add-on diabetes therapies. 7,8 Costs of GLP-1ras are typically higher than other third line diabetes therapies such as TZDs or basal insulin (Table 2). 9,10 A different model suggests liraglutide may be a cost-effective second line agent compared with glimepiride after taking into account reductions in systolic blood pressire, weight and cholesterol.…”

Section: Nice Guidelines On the Use Of Exenatide And Liraglutidementioning

confidence: 99%

GLP-1 receptor agonists in type 2 diabetes - NICE guidelines versus clinical practice

et al. 2014

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Injectable glucagon-like peptide-1 receptor agonists (GLP1ras) have the distinct advantage of promoting weight loss as well as lowering glucose in type 2 diabetes. Treatment with a GLP-1ra is costly, thereby necessitating a restriction on widespread use, thus in the UK the National Institute for Health and Care Excellence (NICE) has published guidance on the use of these drugs.In the UK the Association of British Clinical Diabetologists (ABCD) conducted two nationwide audits on the use of exenatide twice daily and liraglutide once daily and noticed that deviations from NICE guidelines were common. Herein data have been used from both audits (following a combined total of 12,955 type 2 diabetes patients) to evaluate these treatment decisions, critically appraise the NICE guidelines and formulate recommendations for the use of GLP-1ras. Br J Diabetes Vasc Dis 2014;14:52-59

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“…Newer incretinbased therapies offer more options for glycaemic control in T2DM. However, they may confer substantial costs to health care systems as shown in a health-economic analysis carried out to better understand the value of adding exenatide and sitagliptin as second-line therapy to glycaemic control strategies for patients with newonset diabetes [34]. DPP-4 inhibitors are less expensive than GLP-1 receptor agonists, although the difference between the two approaches may vary from country to country and may depend on the dose of liraglutide used (1.2 versus 1.8 mg once daily) and possibly on the mode of administration of exenatide (twice daily versus once weekly).…”

Section: Costmentioning

confidence: 99%

Dipeptidylpeptidase-4 (DPP-4) inhibitors are favourable to glucagon-like peptide-1 (GLP-1) receptor agonists: Yes

Scheen

2012

European Journal of Internal Medicine

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The pharmacological treatment of type 2 diabetes (T2DM) is becoming increasingly complex, especially since the availability of incretin-based therapies. Compared with other glucose-lowering strategies, these novel drugs offer some advantages such as an absence of weight gain and a negligible risk of hypoglycaemia and, possibly, better cardiovascular and β-cell protection. The physician has now multiple choices to manage his/her patient after secondary failure of metformin, and the question whether it is preferable to add an oral dipeptidylpeptidase-4 (DPP-4) inhibitor (gliptin) or an injectable glucagon-like peptide-1 (GLP-1) receptor agonist will emerge. Obviously, DPP-4 inhibitors offer several advantages compared with GLP-1 receptor agonists, especially regarding easiness of use, tolerance profile and cost. However, because they can only increase endogenous GLP-1 concentrations to physiological (rather than pharmacological) levels, they are less potent to improve glucose control, promote weight reduction ("weight neutrality") and reduce blood pressure compared to GLP-1 receptor agonists. Of note, none of the two classes have proven long-term safety and positive impact on diabetic complications yet. The role of DPP-4 inhibitors and GLP-1 receptor agonists in the therapeutic armamentarium of T2DM is rapidly evolving, but their respective potential strengths and weaknesses should be better defined in long-term head-to-head comparative controlled trials. Instead of trying to answer the question whether DPP-4 inhibitors are favourable to GLP-1 receptor agonists (or vice versa), it is probably more clinically relevant to look at which T2DM patient will benefit more from one or the other therapy considering all his/her individual clinical characteristics ("personalized medicine").

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Costs and Consequences Associated With Newer Medications for Glycemic Control in Type 2 Diabetes

Cited by 54 publications

References 32 publications

DPP-4 inhibitors in the management of type 2 diabetes: A critical review of head-to-head trials

DPP-4 inhibitors in the management of type 2 diabetes: A critical review of head-to-head trials

GLP-1 receptor agonists in type 2 diabetes - NICE guidelines versus clinical practice

Dipeptidylpeptidase-4 (DPP-4) inhibitors are favourable to glucagon-like peptide-1 (GLP-1) receptor agonists: Yes

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