Saxagliptin (Onglyza) was listed on the Pharmaceutical Benefits Scheme (PBS) on 1 June 2011.
The authority required (streamlined) listing is for use as dual oral therapy in combination with either metformin or a sulfonylurea in people with type 2 diabetes who:
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have an HbA1c > 7% prior to initiation of a dipeptidyl peptidase 4 (DPP-4) inhibitor (gliptin), a thiazolidinedione (glitazone) or a glucagon-like peptide-1 (GLP-1) analogue despite treatment with either metformin or a sulfonylurea, and
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where a combination of metformin and a sulfonylurea is contraindicated or not tolerated.1
Saxagliptin is not PBS subsidised for use:
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as monotherapy
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in combination with metformin and a sulfonylurea (triple therapy)
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in combination with a glitazone or a GLP-1 analogue
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in combination with other drugs for diabetes.
The listing was on a cost-minimisation basis compared with sitagliptin, with the equi-effective doses of saxagliptin 5 mg/day and sitagliptin100 mg/day.1
Prescribe saxagliptin 5 mg once daily as add-on therapy to metformin or a sulfonylurea.2 When combining saxagliptin with a sulfonylurea, consider lowering the sulfonylurea dose to reduce the risk of hypoglycaemia.
Avoid saxagliptin in people with creatinine clearance < 50 mL/min. No dosage adjustment is required in people with creatinine clearance >50 mL/min or in people with hepatic impairment.
Gliptins improve glycaemic control but as yet have not been shown to reduce diabetes complications. Saxagliptin achieves similar reductions in HbA1c as the other PBS-listed gliptins, sitagliptin and vildagliptin.
For full details, see the updated NPS RADAR review of dipeptidyl peptidase-4 (DPP-4) inhibitors including saxagliptin.3
