Vildagliptin▼(Galvus ®), a dipeptidyl peptidase type 4 (DPP-4) inhibitor and vildagliptin/metformin▼ (Eucreas®) have recently been launched in the UK.
Vildagliptin is licensed for the treatment of type 2 diabetes as dual oral therapy in combination with:
metformin, in patients with insufficient glycaemic control despite maximal tolerated dose of monotherapy with metformin (as a 50mg twice daily dose)
a sulphonylurea, in patients with insufficient glycaemic control despite maximal tolerated dose of a sulphonylurea and for whom metformin is inappropriate due to contraindications or intolerance (as a 50mg once daily dose)
a thiazolidinedione (‘glitazone’), in patients with insufficient glycaemic control and for whom the use of a thiazolidinedione is appropriate (as a 50mg twice daily dose)
The NHS price (excl VAT) is £31.76 for 56x50mg Galvus tablets, 60x 50mg/850mg Eucreas tablets and 60x50mg/1000mg Eucreas tablets.
DPP-4 inhibitors work by enhancing the levels of active incretin hormones, which enhance insulin and reduce glucagon secretions, thereby reducing blood glucose levels. Randomised controlled trials have shown that the addition of vildagliptin 50mg once daily or 50mg twice daily to metformin, glimepiride, or pioglitazone produces statistically significant improvements in glycaemic endpoints versus placebo at 24-weeks. When added to ongoing metformin therapy, vildagliptin was shown to be non-inferior to pioglitazone in HbA1c reduction at 24 weeks.
Further information on vildagliptin will be available in an On the Horizon – Post launch update, due to be published by the NPC shortly.
Management priorities for patients with type 2 diabetes are to control symptoms of diabetes and to reduce the risk of diabetes-related events, in particular cardiovascular disease. Effective drug interventions should be directed towards this, rather than simply showing evidence of reductions in markers of blood glucose control, such as HbA1c.
Currently, only regimens based on metformin have evidence of benefits in patient-oriented outcomes (i.e. living longer or better). Cardiovascular disease is the cause of most of the burden of illness associated with type 2 diabetes and any new therapy should ideally have evidence of benefit in this area before it is routinely used. Such data, in conjunction with robust cost-effectiveness analyses, would inform an assessment of the potential role of vildagliptin in relation to existing therapies used in the overall management of type 2 diabetes.