Alogliptin, latest DPP4 inhibitor, launched by Takeda
Type II diabetes patients now have an additional dipeptidylpeptidase-4 (DPP4) inhibitor treatment option available — alogliptin.
Sally James, divisional pharmacist for medicine, specialising in diabetes, at the Royal Liverpool Hospital, explained: “Alogliptin is the fifth and latest DPP4 inhibitor to be licensed in the UK for the treatment of diabetes.” She added that the new drug is competitively priced compared with the other DPP4s currently on the market but that otherwise it does not offer any huge advantage.
Alogliptin is licensed for the treatment of type II diabetes to improve glycaemic control in combination with other glucose lowering medicinal products including insulin, when these, with diet and exercise do not provide adequate glycaemic control. However, it is recommended that a lower dose of a sulphonylurea or insulin is used when combined with alogliptin because of the increased risk of hypoglycaemia. Furthermore, the summary of product characteristics states that alogliptin has not been studied as triple therapy with metformin and sulphonylurea, and caution should be exercised, highlighted Ms James.
The medicine was approved by the European Medicines Agency in September 2013 and will be marketed as Vipidia by Takeda — the recommended dose is 25mg once daily. Ms James also pointed out that lower strengths are available for patients with different stages of renal impairment. In addition, it is available in combination with metformin in a 12.5mg strength, which will be marketed as Vipdomet by Takeda.
A study in The New England Journal of Medicine, published in September 2013, found no increase in risk of cardiovascular events associated with alogliptin (2013;369:1327). The study was conducted because of fears that antidiabetic medicines could cause adverse cardiovascular outcomes.
Ms James added that the National Institute for Health and Care Excellence produced an evidence summary for alogliptin in May 2013 and there are no further plans for it to be reviewed.
The most common side effects associated with alogliptin are: upper respiratory tract infection, nasopharyngitis, headache, abdominal pain, gastro-oesophageal reflux disease, pruritis and rash.
Action: Inhibitis dipeptidylpeptidase-4
Dose: One 25mg tablet daily, as add-on therapy to metformin, a thiazolidinedione, a sulphonylurea, or insulin, or as triple therapy with metformin and a thiazolidinedione or insulin. The summary of product characteristics contains further recommendations for dosing during combination therapy. For patients with moderate renal impairment the recommended dose is 12.5mg and for patients with severe renal impairment the recommended dose is 6.25mg
Legal Category: POM
NHS list price: 28 x 25mg tablets, 28 x 12.5mg tablets, 28 x 6.25mg tablets and 28 x 12.5mg/1,000mg metformin tablets (Vipdomet), all £26.60
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.11133298
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