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NICE approves three SGLT2 inhibitors as monotherapy

NICE have released a new technology appraisal recommending three sodium–glucose cotransporter 2 (SGLT2) inhibitors – canagliflozin (Invokana; Janssen), dapagliflozin (Forxiga; AstraZeneca) and empagliflozin (Jardiance; Boehringer Ingelheim and Lilly UK) – as monotherapies for people with type 2 diabetes.

The treatments are recommended as options for treating type 2 diabetes in adults for whom metformin is contraindicated or not tolerated and when diet and exercise alone do not provide adequate glycaemic control. However, they are only recommended if a dipeptidyl peptidase‑4 (DPP‑4) inhibitor would otherwise be prescribed, and if a sulfonylurea or pioglitazone is not appropriate.

Adults who are not recommended to receive monotherapy with these agents in the new guidance but who had already started before publication should be able to continue treatment until they and their NHS clinician consider it appropriate to stop.

The guidance and evidence base can be read in full at https://www.nice.org.uk/guidance/TA390.

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