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Canagliflozin, dapagliflozin and empagliflozin monotherapy for treating type 2 diabetes : systematic review and economic evaluation
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Johnston, Rhona, Uthman, Olalekan A., Cummins, Ewen, Clar, Christine, Royle, Pamela, Colquitt, Jill, Tan, Bee K., Clegg, Andrew, Shantikumar, Saran, Court, Rachel A., O'Hare, J. Paul, McGrane, David, Holt, Tim and Waugh, Norman (2017) Canagliflozin, dapagliflozin and empagliflozin monotherapy for treating type 2 diabetes : systematic review and economic evaluation. Health Technology Assessment, 21 (2). pp. 1-218. doi:10.3310/hta21020 ISSN 1366-5278.
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Official URL: http://dx.doi.org/10.3310/hta21020
Abstract
Background
Most people with type 2 diabetes are overweight, so initial treatment is aimed at reducing weight and increasing physical activity. Even modest weight loss can improve control of blood glucose. If drug treatment is necessary, the drug of first choice is metformin. However, some people cannot tolerate metformin, which causes diarrhoea in about 10%, and it cannot be used in people with renal impairment. This review appraises three of the newest class of drugs for monotherapy when metformin cannot be used, the sodium–glucose co-transporter 2 (SGLT2) inhibitors.
Objective
To review the clinical effectiveness and cost-effectiveness of dapagliflozin (Farxiga, Bristol-Myers Squibb, Luton, UK), canagliflozin (Invokana, Janssen, High Wycombe, UK) and empagliflozin (Jardiance, Merck & Co., Darmstadt, Germany), in monotherapy in people who cannot take metformin.
Sources
MEDLINE (1946 to February 2015) and EMBASE (1974 to February 2015) for randomised controlled trials lasting 24 weeks or more. For adverse events, a wider range of studies was used. Three manufacturers provided submissions.
Methods
Systematic review and economic evaluation. A network meta-analysis was carried out involving the three SGLT2 inhibitors and key comparators. Critical appraisal of submissions from three manufacturers.
Results
We included three trials of dapagliflozin and two each for canagliflozin and empagliflozin. The trials were of good quality. The canagliflozin and dapagliflozin trials compared them with placebo, but the two empagliflozin trials included active comparators. All three drugs were shown to be effective in improving glycaemic control, promoting weight loss and lowering blood pressure (BP
| Item Type: | Journal Article | ||||||
|---|---|---|---|---|---|---|---|
| Subjects: | R Medicine > RC Internal medicine | ||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Non-insulin-dependent diabetes -- Treatment -- Cost effectiveness, Systematic reviews (Medical research) | ||||||
| Journal or Publication Title: | Health Technology Assessment | ||||||
| Publisher: | NIHR Health Technology Assessment programme | ||||||
| ISSN: | 1366-5278 | ||||||
| Official Date: | January 2017 | ||||||
| Dates: |
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| Volume: | 21 | ||||||
| Number: | 2 | ||||||
| Page Range: | pp. 1-218 | ||||||
| DOI: | 10.3310/hta21020 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||
| Date of first compliant deposit: | 24 January 2017 | ||||||
| Date of first compliant Open Access: | 25 January 2017 | ||||||
| Funder: | National Institute for Health Research (Great Britain). Technology Assessment Programme (NIHR TAP) |
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