Janssen’s Invokana has become the latest drug to be recommended for NHS use in England and Wales to lower blood sugar levels in people with type 2 diabetes.
Final guidance published by the National Institute for Health and Care Excellence (NICE) makes the sodium glucose co-transporter (SGLT-2) the tenth treatment that type 2 diabetes patients have guaranteed access to on the NHS.
Invokana (canagliflozin) is also the second SGLT-2 backed by NICE following the approval last year of AstraZeneca’s (AZ) Forxiga (dapagliflozin).
Both drugs work in a similar way by blocking the re-absorption of glucose by the kidney, increasing the amount of glucose secreted in the urine.
This means they can be used in combination with drugs, such as insulin, that impact blood sugar levels directly, and they also have a reduced risk of hypoglycaemia – a side effect associated with diabetes treatments where blood sugar levels drop to a dangerously low level.
As such, the guidance for Invokana covers its use in a variety of combinations, including alongside metformin in patients who cannot take a sulfonylurea or who are at significant risk of hypoglycaemia.
Invokana is also recommended for cases when people need to take three diabetes treatments if used in combination with either metformin and a sulfonylurea, or metformin and a thiazolidinedione.
Lastly, Invokana is recommended as a possible treatment when taken with insulin, with or without other oral diabetes treatments. These recommendations put it on a similar footing to rival Forxiga, which is also a once-daily treatment.
Professor Carole Longson, director of NICE’s Centre for Health Technology Evaluation, explained the persistent need for new diabetes medicines.
“Treatment needs can vary from person to person which means clinicians need access to a number of drugs if they are to successfully control type 2 diabetes.”
Janssen’s UK medical director Dr Peter Barnes said the recommendation was an “important milestone” for the drug, which was approved in Europe earlier this year.
Janssen’s Invokana was also granted European approval for a fixed dose combination with metformin that will be marketed as Vokanamet, putting it on an equal setting to AstraZeneca, which markets a Forxiga/metformin combination in the form of Xigduo.
Further behind these two companies is Boehringer Ingelheim and Lilly whose own SGLT-2 inhibitor Jardiance was only approved in May this year and has been delayed in the US after manufacturing issues. A Jardiance/metformin combination is also in the works.