NICE set to recommend type 2 diabetes drug empagliflozin

Pill will sit alongside an arsenal of other sugar-lowering medicines

NICE has issued further draft guidance which recommends empagliflozin, marketed by Boehringer Ingelheim, for treating type 2 diabetes.

In a preliminary appraisal last August, NICE called for the company to provide more evidence to demonstrate that empagliflozin is a good use of NHS resources when compared with other treatments that are already available.

Boehringer responded and submitted a new cost-effectiveness model which showed that empagliflozin combination therapy is a cost effective treatment option for some people with type 2 diabetes.

Commenting on the draft guidance Professor Carole Longson, director of the NICE centre for health technology evaluation, said: “We are pleased that Boehringer Ingelheim responded to our consultation and provided new evidence to allow us to recommend empagliflozin as a treatment option for some people with type 2 diabetes.

“Millions of people in England are affected by type 2 diabetes. There are already several NICE recommended treatments specifically for managing blood sugar levels, however each has its advantages and disadvantages that affect how suitable they are for each individual.

“With the addition of empagliflozin to our varied arsenal of treatments for type 2 diabetes, people will now have even more choice to ensure they get the treatment that is right for them.”

Empagliflozin (marketed as Jardiance) works by blocking the reabsorption of glucose in the kidneys which is instead passed out of the body in the urine. It is an oral, once-daily medication belonging to a class of drugs called sodium glucose co-transporter (SGLT-2) inhibitors.

The draft guidance is now with consultees, who have the opportunity to appeal against it. Until NICE issues final guidance, NHS bodies should make decisions locally on the funding of specific treatments.

The specific guidance sees empagliflozin recommended as an option for treating type 2 diabetes:

  • In a dual therapy regimen in combination with metformin, only if:
    – a sulfonylurea is contraindicated or not tolerated, or
    – the person is at significant risk of hypoglycaemia or its consequences.
  • In a triple therapy regimen in combination with:
    – metformin and a sulfonylurea or
    – metformin and a thiazolidinedione.
  • In combination with insulin with or without other antidiabetic drugs.

The recommended starting dosage is 10mg once daily for both monotherapy and as an add-on combination therapy with other glucose lowering medicinal products including insulin.

The dosage can be increased to a maximum of 25mg daily for people who tolerate empagliflozin well and need tighter glycaemic control, if they have an estimated glomerular filtration rate (eGFR) of 60 ml/min/1.73 m2 or more.

The cost of empagliflozin is £36.59 per pack of 28 tablets for both 10mg and 25mg doses with the annual cost of empagliflozin estimated to be £477.30.

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