The National Institute for Health and Clinical Excellence (NICE) has issued a draft recommendation backing the use of Eli Lilly's Bydureon (exenatide prolonged-release suspension for injection) in triple-therapy options for people with type 2 diabetes, when control of blood glucose remains or becomes inadequate.
NICE's preliminary guidance says that Bydureon may be used - in combination with metformin and a sulphonylurea, or metformin and a thiazolidinedione - in such patients if they also have:
- a body mass index (BMI) of 35kg/m2 or higher in those of European family origin (with appropriate adjustment for other ethnic groups) and specific psychological or medical problems associated with high body weight; or
- a BMI below 35kg/m2, for whom therapy with insulin would have significant occupational implications or weight loss would benefit other significant obesity-related comorbidities.
Treatment with Bydureon in a triple-therapy regimen should only be continued if a beneficial metabolic response has been shown, says NICE.
It also recommends use of the drug in dual-therapy regimens (in combination with metformin or a sulphonylurea) for type 2 diabetes only if:
- either metformin or a sulphonylurea, or a treatment with metformin or a sulphonylurea, is contraindicated or not tolerated; and
- thiazolidinediones and dipeptidyl peptidase-4 (DPP-4) inhibitors, or treatment with thiazolidinediones and DPP-4 inhibitors are contraindicated or not tolerated.
Again, treatment with Bydureon in a dual-therapy regimen should only be continued if a beneficial metabolic response has been shown, says NICE.
Bydureon improves glycaemic control in patients with type 2 diabetes in a number of ways, says NICE. These include: - enhanced glucose-dependent insulin secretion, resulting in the release of a higher, more appropriate amount of insulin that helps lower the rise in blood sugar from eating; and - reduced glucose-dependent glucagon secretion in response to eating, which helps stop the liver from overproducing sugar when it is not needed, thus preventing hyperglycaemia.
Professor Carole Longson, director of NICE's Health Technology Evaluation Centre, noted that, with type 2 diabetes becoming increasingly more common in adults, the Institute is pleased to recommend the drug as a treatment option for some people with the condition.
Public comment on the draft recommendations are now invited until November 8 at 5.00 pm, and it is expected that NICE will publish its final guidance next February.