NICE backs freer use of SGLT2 inhibitors for diabetes

The National Institute of Health and Care Excellence (NICE) has recommended that SGLT2 inhibitors on the UK market can be used earlier on 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 Takeda's Actos (pioglitazone) are not considered appropriate.

Importantly the recommendations put the SGLT2 inhibitors on a 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 Forxiga (dapagliflozin) and Boehringer Ingelheim/Eli Lilly's Jardiance (empagliflozin). They work in a different way to current oral antidiabetic drugs, blocking the re-absorption of glucose by the kidney and increasing the amount of glucose secreted in the urine.

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".

NICE estimates that around 31,000 of the 3 million people in the UK with diabetes may be eligible for treatment with the SGLT2 inhibitors, which it says cost on average around £475 per year and are as cost-effective as DPP-4 inhibitors.

It is well recognised that individualised care is critical in diabetes because there is no 'one size fits all' treatment, said Prof Carole Longson, director of NICE's Centre for Health Technology Evaluation, noting that SGLT2 inhibitors are now "an alternative to the separate group of drugs called DPP-4 inhibitors".

"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," she added.

While the growth of the SGLT2 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.