Type 2 diabetes

PBS subsidies for oral triple therapy with DPP-4 and SGLT2 inhibitors

Triple oral therapy with a DPP-4 inhibitor and SGLPT2 inhibitor in addition to metformin will be subsidised on the PBS from 1 April.

Fixed dose combinations of SGLP2 inhibitors and gliptins are among a raft of diabetes treatments to be listed on the PBS, in addition to a longer-acting insulin glargine product, Toujeo.

A combination of dapagliflozin with saxagliptin (Qtern) will be PBS listed for use in triple oral therapy in combination with metformin for patients with type 2 diabetes mellitus, according to an announcement made by Federal minister for Health Greg Hunt on 26 March.

A fixed dose combination of empagliflozin and linagliptin (Glyxambi) will be another PBS listed option. The Authority Required (Streamlined) listing also applies to dapagliflozin with metformin (Xigduo XR), and dapagliflozin (Forziga).

The minister said PBS listing criteria will also be expanded for empagliflozin (Jardiance), empagliflozin with metformin (Jardiamet), and linagliptin with metformin (Trajentamet). In addition, vildagliptin (Galvus) and vildagliptin with metformin (Galvumet), which will also be available for the treatment of type 2 diabetes mellitus, he said.

The announcement was welcomed by Professor Mark Cooper of the Department of Diabetes, Monash University,  Melbourne, who said triple oral therapy with a SGLT2 inhibitor and DPP-4 inhibitor could enable patients to reduce HbA1c levels by an additional 0.5%. The newer agents also had the advantage of  avoiding weight gain seen with older glucose-lowering agents and they conferred protection against cardiovascular and renal disease, he added.

“These offer better glycaemic control and that means fewer complications and fewer patients requiring insulin,” he told the limbic.

The PBS-subsidised availability of fixed combinations would also be good for adherence, he added.

Also announced for PBS listing is a once daily Toujeo Solostar insulin pen that contains a longer-acting formulation of insulin glargine (300 units/mL) compared with current Lantus (insulin glargine 100 units/ml).

The product is intended for once daily administration and has been available on private prescription since December 2016. Manufacturer Sanofi says it is important to note that this strength of insulin glargine (300 units/mL is not bioequivalent and therefore not automatically interchangeable to other basal insulins and will require dose adjustment.

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