Alogliptin: DPP-4 Inhibitor of Choice

The position of alogliptin in the NHSGGC Formulary has changed.  The previous prescribing restriction limiting use in dual therapy has been removed.

One of this year’s prescribing initiatives in primary care is to review prescribing of DPP-4 inhibitor drugs. The aims are to:

• ensure prescribing is in line with NHSGGC Type 2 Diabetes Management Guideline,
• ensure that treatment is only continued if HbA1C level has reduced by 6 mmol/mol (0.5%) at 6 months
• change to alogliptin within its licensed indications as a cost-efficiency unless clinically inappropriate

Agents within the class of DPP-4 inhibitors are considered to be similarly efficacious and NICE recommends that, where all other factors are equal, the DPP-4 inhibitor with the lowest cost should be prescribed. DPP-4 inhibitors are not considered the most cost-effective choice when used as first-line therapy, and even when used as second or third line, they may only result in a modest reduction of HbA1c. 

A review may result in a change to alogliptin, see treatment stopped or an alternative agent started altogether but will create some capacity for the increased use of sodium-glucose co-transporter 2 (SGLT2) inhibitors (canagliflozin, dapagliflozin, or empagliflozin). In addition the primary care review creates an opportunity to apply Realistic Medicine in patients with diabetes.