According to the TAG, SGLT-2 inhibitors, including canagliflozin, as monotherapy are recommended as an option for treating Type 2 diabetes in adults for whom metformin is contraindicated or not tolerated and when diet and exercise alone do not provide adequate glycaemic control, only if:
- A dipeptidyl peptidase-4 (DPP-4) inhibitor would otherwise be prescribed; and
- A sulfonylurea or pioglitazone is not appropriate.
The TAG also explains that patients who have already started treatment with SGLT-2 inhibitors within the NHS, and who are no longer suitable for treatment under this new guidance, may continue treatment until their NHS healthcare provider considers it appropriate to stop.
It is estimated that 4 million people in the UK live with diabetes, and of these 90% have Type 2 diabetes. People with diabetes in England and Wales are 34.4% more likely to die earlier than their peers. For Type 2 diabetes, mortality is 32% greater than expected.
Good diabetes management has been shown to reduce the risk of complications, and achieving early HbA1c (glycated haemoglobin) control to below 6.5% is associated with a better long-term outcome for patients with diabetes. However, only 37.4% of people with Type 2 diabetes are achieving recommended targets. HbA1c measurements in the blood provide an overall picture of what the average blood sugar levels have been over a period of weeks/months.
Rozlyn Bekker, medical director at pharmaceutical Janssen UK, said: “This is welcome news that suitable adults with Type 2 diabetes can now benefit from treatment with canagliflozin earlier in the treatment pathway.
“Canagliflozin has the potential to contribute towards an improved quality of life for patients living with diabetes, and when used appropriately it offers value to the NHS.”
In November 2013, the European Commission approved canagliflozin in the European Union for the treatment of adults with Type 2 diabetes mellitus, to improve glycaemic control.
Type 2 diabetes is a chronic disease that requires lifelong management. After diet and lifestyle advice, patients who continue to not have adequately controlled blood glucose will start on a single anti-hyperglycaemic medication. It is important to achieve good glycaemic control and good tolerability with treatment from the start. However, over time, if blood glucose remains uncontrolled then other anti-hyperglycaemic medications may be added to this initial treatment.
Canagliflozin has been studied as monotherapy and in combination with other anti-hyperglycaemic agents for Type 2 diabetes, including insulin. The comprehensive global Phase 3 clinical trial programme for canagliflozin enrolled 10,285 patients in 9 studies and is one of the largest programmes for a pharmacological product being studied for glycaemic control in Type 2 diabetes.