Original Title: Canagliflozina, empagliflozina y dapagliflozina (SGLT-2) en pacientes con diabetes tipo 2

Authors' recommendations: CONCLUSIONS High-quality evidence shows that the use of canagliflozin, empagliflozin or dapagliflozin (SGLT-2) in combination with other anti-diabetic drugs in patients at high cardiovascular risk and refractory to metformin decreases overall and cardiovascular mortality, when compared to placebo and dipeptidyl peptidase-4 (DPP-4) enzyme inhibitors and there are no differences when compared to glucagon-like peptide 1 (GLP-1) analogues. The SGLT-2s reduce glycosylated hemoglobin levels just like most antidiabetic drugs, although slightly less than GLP-1. SGLT-2s are also associated with a mild decrease in body weight, which might impact on quality of life improvement. Regarding safety, SGLT-2s present fewer serious adverse events than DPP-4 and GLP-1, with a slight increase in mild genital infections and, in the case of canagliflozin, a probable increase in renal adverse events. Moderate-quality evidence suggests that SGLT-2s as monotherapy for those patients with contraindications for or intolerant to metformin, would slightly reduce glycosylated hemoglobin levels when compared to sulfonylureas, thiazolidinediones and some drugs of the DPP-4 class. The clinical practice guidelines surveyed mention SGLT-2s among the therapeutic options both for refractory diabetes and as monotherapy when there is a contraindication to receive metformin. They suggest that one antidiabetic drug or the other should be indicated on case by case basis, taking several factors into account. Mexico and most health sponsors from high-income countries cover this technology for patients who are refractory to metformin treatment, who may not receive other more cost-effective antidiabetic drugs such as sulfonylureas or thiazolidinediones. Most sponsors surveyed do not cover or mention this technology as monotherapy for patients with contraindications for or intolerant to metformin. No cost-effectiveness studies were found in Argentina. Economic assessments from other countries found that SGLT-2 was cost-effective when compared to DPP-4 and the retail price in Argentina is similar in both groups.

Project Status: Completed

Year Published: 2019

URL for published report: https://www.iecs.org.ar/home-ets/

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)