5.2 dapagliflozin summary sheet

Dapagliflozin for the management of type 2 diabetes
21/8/2013

Decision Summary
Date of DTG
DTG Decision
Date of LAPC
Traffic Light List
Date of funding
Funding decision
Commissioning
Other considerations

Application summary
• Dapagliflozin is a sodium-glucose co-transporter-2 inhibitor, which blocks reabsorption of glucose by the kidneys, licensed for use in adults over 18 with type 2 diabetes mellitus to improve glycaemic control. • Dapagliflozin has been considered in NICE TA288. The application is for use in line with this guidance. • The endocrinology team do not anticipate starting a significant number of patients on this product - it is thought that the majority of initiation will take place in primary care • The cost across Leeds is estimated by NICE to be approximately £188,000 per year. The costs to LTHT will be due to patients being admitted on the product. Because of this, it is not possible to estimate LTHT costs, or the particular CSUs which will be affected.
Place in therapy / pathway
As per NICE TA288:
1.1 Dapagliflozin in a dual therapy regimen in combination with metformin is recommended as an option for treating
type 2 diabetes, only if it is used as described for dipeptidyl peptidase-4 (DPP-4) inhibitors in Type 2 diabetes: the
management of type 2 diabetes (NICE clinical guideline 87).
1.2 Dapagliflozin in combination with insulin with or without other antidiabetic drugs is recommended as an option
for treating type 2 diabetes.
1.3 Dapagliflozin in a triple therapy regimen in combination with metformin and a sulfonylurea is not recommended
for treating type 2 diabetes, except as part of a clinical trial.
1.4 People currently receiving dapagliflozin in a dual or triple therapy regimen that is not recommended for them in
1.1 or 1.3 should be able to continue treatment until they and their clinician consider it appropriate to stop.
From NICE CG87:
1.6.1.1 Consider adding a DPP-4 inhibitor instead of a sulfonylurea as second-line therapy to first-line metformin
when control of blood glucose remains or becomes inadequate (HbA1c ≥ 6.5%, or other higher level agreed with the
individual) if:
• the person is at significant risk of hypoglycaemia or its consequences,or • the person does not tolerate a sulfonylurea or a sulfonylurea is contraindicated. 1.6.1.4 Only continue DPP-4 inhibitor therapy if the person has had a beneficial metabolic response (a reduction of
at least 0.5 percentage points in HbA1c in 6 months).
Points for consideration
• NICE TA288 recommends the use of dapagliflozin. This application is in line with TA288. • NICE state: “When NICE recommends a treatment 'as an option', the NHS must make sure it is available within [3 months of publicaton]. This means that, if a patient has type 2 diabetes and the doctor responsible for their care thinks that dapagliflozin is the right treatment, it should be available for use, in line with NICE's recommendations.”

Source: http://www.leedsformulary.nhs.uk/docs/DTGDapagliflozin1309.pdf