Finding the most cost-effective option from commonly used Dipeptidyl peptidase-4 inhibitors in India: a systematic study.

OBJECTIVE: To identify a preferred and cost-effective drug among Dipeptidyl peptidase-4 inhibitors (DPP4Is) for Indian patients with T2DM. METHODS: We performed a systematic literature search using standard databases for relevant literature. Original studies comparing the efficacy and/or safety of different DPP4Is were included. Two authors independently performed the literature search, screening, and collected relevant data from the selected studies. The costs of all brands of individual DPP4Is were noted and compared for lowest, highest, and average cost. Finally, we summarized the information with respect to Efficacy, safety, suitability, and cost to find the most cost-effective DPP4I. RESULTS: We found 13 eligible studies containing data on 15,720 subjects. These studies showed similar efficacy (or better) and safety with teneligliptin as compared to other DPP4Is. Teneligliptin also showed additional benefits other than the glycemic control. The average cost per tablet of teneligliptin 20 mg was markedly lower as compared to sitagliptin, vildagliptin, and other commonly used DPP4Is. Teneligliptin also outscored other commonly used DPP4Is in India in suitability and seems to have better patient compliance. CONCLUSIONS: Teneligliptin 20 mg could be considered as the preferred and most cost-effective agent among commonly used DPP4Is for the effective management of patients with T2DM in India.

Alternate-day add-on therapy with dapagliflozin in patients with type 2 diabetes mellitus: potential benefits and concerns.

INTRODUCTION: Factors such as compliance, cost and safety play a major role in achieving the long-term goal in the management of type 2 diabetes mellitus (T2DM). Dapagliflozin carries a great potential of becoming an alternate-day therapy because of its favorable pharmacological properties. AREAS COVERED: In this review, we have discussed and hypothesized the potential of dapagliflozin as an alternate-day add-on drug in T2DM patients. We have discussed the properties by virtue of which it carries a potential to become an alternate-day therapy. We have also explained the potential benefits and concerns of using this approach. EXPERT OPINION: Alternate-day add-on therapy with dapagliflozin could be a promising approach in reducing the cost, improving the treatment satisfaction and reducing the adverse effects. However, this propsed indication demands an in-depth investigation among T2DM subjects who are not able to achieve glycemic control with standard monotherapy or combination therapy. Pilot studies or some small-scale investigator-initiated trials or academic clinical trials may be carried out to explore this concept. At the same time, large industry sponsored multicenter clinical trials including pharmacoeconomic analyses may be planned to have a more detailed investigation.