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Introducing Steglatro – the newest Gliflozin soon to be PBS listed

By Donna Itzstein

Diabetes Queensland Pharmacist

 

Steglatro is the newest offering from pharmaceutical company Merck Sharp & Dohme of Ertugliflozin for type 2 diabetes.

 

At the July meeting, the Pharmaceutical Benefits Advisory Committee (PBAC) recommended the Authority Required (STREAMLINED) listing of Ertugliflozin with Sitagliptin fixed dose products for use in combination with metformin as triple oral therapy in patients with type 2 diabetes.

 

The PBAC recommends PBS listing based on cost, safety and efficacy being the same as Dapagliflozin or Empagliflozin (1).

 

Ertugliflozin blocks the sodium glucose cotransporter-2 (SGLT2) in the proximal tubules of the kidney. 

 

This action removes about 40 per cent of glucose, which would have been reabsorbed. This is 70g of glucose per day, dragging about 375ml water with it.

 

This estimate depends on renal function and carbohydrate load.  

 

Expected actions include:

 

Brands, Strengths and dosing available in USA

Steglatro

Ertugliflozin

Once daily in the morning

15mg, 5mg

Segluromet

Ertugliflozin/ Metformin

twice daily

2.5/500mg, 2.5/1000 mg

7.5/500mg, 7.5/1000mg

Steglujan

Ertugliflozin/ Sitagliptin

Once daily in the morning

5 mg/100 mg & 15 mg/100 mg

 

Clinical information on SGLT2 inhibitors

  • SGLT2 inhibitors are indicated for adult type 2 diabetes. They are being administered off-label in type 1 diabetes to reduce insulin requirements with the side benefit to cardiovascular risk. Trials with promising results are underway in paediatric type 2 diabetes.
  • Urinary tract infection and genital mycotic infection rates are significantly increased with SGLT2 inhibitors and predominantly in females. An increased but minute rate of genital gangrene is observed with these agents. Volume depletion-related adverse events due to the diuresis are reduced by adequate fluid intake. 
  • Euglycaemic ketoacidosis occurs more frequently when the body is under stress. Temporary withdrawal during illness or in low carbohydrate diets is the best option.  This frequency increases when used in type 1 diabetes.
  • Renal function is preserved long-term; however, acute renal failure may happen upon initiation of SGLT2 inhibitors. Check renal function.
  • Consider ceasing other diuretics to decrease the possibility of hypovolaemia. Consider SGLT2 inhibitors carefully in elderly. These agents increase the risk of fractures, falls.
  • SGLT2 inhibitors increase the risk of hypoglycaemia when used with insulin and sulfonylureas. Consider reducing the dose of these agents

 

Counselling tips for your patients

  • SGLT2 inhibitors may improve cardiovascular risk.
  • Euglycaemic acidosis is rare. Consider counselling to withdraw when ill to be aware of symptoms.
  • Remind patients on the value of foot care. There is a small but increased possibility of amputation risk.
  • The patient's urine contains glucose at all times while taking these agents.
  • Urinary tract infections and genital infections (thrush) are more likely. Maintain good hygiene and counsel on symptoms. Encourage reporting symptoms immediately.
  • Drink adequate water.
  • If your patient is using these agents with insulin or a sulfonylurea, counsel them on hypoglycaemia.

 

For more information on this article or general enquiries, please contact us on 1300 136 588.

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