NICE says yes to new diabetes drugs

Three newer treatments for diabetes from AstraZeneca, Janssen and Boehringer Ingelheim have been recommended by NICE, and can be used as frontline treatment for some patients.

The approval set out in final guidance is good news for the companies involved, but still limits use of the SGLT2 inhibitor drugs - AstraZeneca's Forxiga (dapagliflozin), Janssen's Invokana (canagliflozin) and Boehringer Ingelheim's Jardiance (empagliflozin).

Emerging evidence suggests the drugs could become the treatment of choice in patients who can control their condition with oral treatments, but NICE says they should only be used if metformin is contraindicated and generic drugs pioglitazone or sulfonylureas are not appropriate options.

The guidance found that the SGLT2 inhibitor drugs are cost effective compared to the more established DPP-4 drugs, such as MSD's Januvia (sitagliptin), and the guidance suggests that doctors can choose between drugs in either class.

Clinical experts stress that 'no one size fits all' in oral treatment for diabetes, and hence want a broader range of drugs to choose from. NICE has responded to this call by giving doctors the "freedom to prescribe SGLT2 inhibitors when they feel it appropriate."

While there are concerns about serious urinary tract infections sometimes caused by the drugs, the SGLT2 inhibitor class has also show signs of being superior to existing treatments in terms of lowering blood glucose and reducing weight.

Boehringer Ingelheim's Jardiance has shown particular promise, a major cardiovascular outcomes trial unveiled last year showing a significant reduction in deaths from heart attacks and strokes, but this isn't reflected in the new NICE guidance.

NICE ruled that the evidence did not support recommending any of the three SGLT2 drugs ahead of its rivals, judging them to be on an equal footing in terms of price and clinical evidence.

Diabetes is one of the biggest health problems in England, largely due to rising levels of obesity, and treating the condition and its complications is taking up an increasing part of the NHS budget.

Around 2.7 million people in England of 17 and over had a diagnosis of diabetes in 2013, of whom 90% had type 2 diabetes. However, many people with type 2 diabetes are undiagnosed, and so the number of people with the condition may be higher than reported.

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