A NICE technology appraisal guidance addresses the use of dapagliflozin in patients already taking two oral antidiabetic medications. There are two recommendations, which replace recommendation 1.3 of NICE’s guidance for using the drug in combination therapy.
- Dapagliflozin in triple therapy is an option only in combination with metformin and a sulfonylurea.
- It should not affect the treatment of patients already using dapagliflozin with other drug combinations at the time of publication.
The recommendations are based on evidence of clinical effectiveness, including dapagliflozin’s positive effects on weight and blood pressure, and also on evidence that patients appreciate a third oral treatment option to escalate antidiabetic medication before having to resort to injectable drugs.
The committee noted, however, that there is as yet no consensus on the most appropriate point in the treatment pathway to introduce dapagliflozin. NICE currently recommends it as dual therapy only if sulfonylurea is contraindicated or not tolerated, or if a patient is at significant risk for hypoglycemia.
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