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The effect of laquinimod, a novel immuno-modulator in development to treat Huntington disease, on the pharmacokinetics of ethinylestradiol and levonorgestrel in healthy young women. Eur J Clin Pharmacol 2018; 75:41-49. [DOI: 10.1007/s00228-018-2549-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
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2
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Jusko WJ. Perspectives on variability in pharmacokinetics of an oral contraceptive product. Contraception 2016; 95:5-9. [PMID: 27475034 DOI: 10.1016/j.contraception.2016.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
The early literature and reviews have described the pharmacokinetics (PK) of oral contraceptive (OC) compounds such as ethinyl estradiol (EE) and levonorgestrel (LNG) in women as subject to large intersubject variability. This was partly due to the use of diverse radioimmunoassays, limited sampling periods and an incomplete understanding of single- vs. multiple-dose kinetics and the role of EE in causing both inhibition of hepatic metabolism along with induction of sex hormone binding globulin. Over the past two decades, LNG and EE have been used as target drugs for the assessment of possible drug interactions upon introduction of many new therapeutic agents. This has resulted in at least 17 publications that describe the PK of LNG and EE in women using various 150 mcg/30 mcg products under fairly standard multiple-dose conditions. A review of these studies indicates only moderate variability in the Cmax and area under the curve both within and across these studies. There is impressive similarity in these drug exposure indices found in studies carried out with several products by investigators at numerous sites and countries.
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Affiliation(s)
- William J Jusko
- Department of Pharmaceutical Sciences, University at Buffalo, 404 Kapoor Hall, Buffalo, NY 14214, USA.
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3
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Efficacy and safety of empagliflozin as add-on to metformin for type 2 diabetes: a systematic review and meta-analysis. Eur J Clin Pharmacol 2016; 72:655-63. [DOI: 10.1007/s00228-016-2010-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 01/11/2016] [Indexed: 02/06/2023]
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Dixit D, Yoon Y, Volino LR, Mansukhani RP. Empagliflozin: a sodium-glucose cotransporter 2 inhibitor for treatment of type 2 diabetes. Am J Health Syst Pharm 2015; 72:1943-54. [PMID: 26541949 DOI: 10.2146/ajhp150071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The pharmacology, pharmacokinetics, pharmacodynamics, clinical efficacy, adverse effects, dosage and administration, and drug-drug interactions of empagliflozin are reviewed. SUMMARY Empagliflozin is a direct inhibitor of sodium-glucose cotransporter 2 (SGLT2), which acts to lower the renal threshold and increase urinary glucose excretion. SGLT2 is found in the proximal tubules of the kidneys and reabsorbs about 90% of the filtered glucose. Because the mechanism of action of empagliflozin is not insulin dependent or insulin sensitive, it may be used in patients at different stages of diabetes with nonfunctional or impaired pancreatic β cells. Furthermore, empagliflozin can be used with other antidiabetic drugs due to its lack of any additive hypoglycemic effects. Long-term efficacy studies revealed significant reductions with empagliflozin in glycosylated hemoglobin (HbA1c) values at week 78 compared with placebo. Secondary endpoints in clinical trials showed improvements in lowering blood pressure and reductions in body weight. The risk:benefit ratio must be assessed for empagliflozin as the safety profile includes an increase in urinary and genital infections. CONCLUSION Empagliflozin has shown efficacy in lowering HbA1c and blood glucose levels both as monotherapy and as an add-on to existing therapy. Despite the drug's promising outlook, empagliflozin also leads to common but serious adverse events not seen with other classes of antihyperglycemic agents. Considering the current data on its efficacy and its safety profile, empagliflozin can be used as a second- or third-line agent in treating diabetes.
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Affiliation(s)
- Divisha Dixit
- Divisha Dixit, Pharm.D., is Postdoctoral Associate, Pharmaceutical Fellowship Program, Ernest Mario School of Pharmacy at Rutgers, State University of New Jersey (SUNJ), Piscataway; at the time of writing she was a Pharm.D. student, Ernest Mario School of Pharmacy at Rutgers, SUNJ. Youngmin Yoon, is Pharm.D. student, Ernest Mario School of Pharmacy at Rutgers, SUNJ. Lucio R. Volino, Pharm.D., is Clinical Assistant Professor, Ernest Mario School of Pharmacy at Rutgers, SUNJ, and Clinical Pharmacist, Great Atlantic and Pacific Tea Company, Kenilworth, NJ. Rupal Patel Mansukhani, Pharm.D., is Clinical Assistant Professor, Ernest Mario School of Pharmacy at Rutgers, SUNJ, and Clinical Pharmacist, Transitions of Care, Morristown Medical Center, Morristown, NJ
| | - Youngmin Yoon
- Divisha Dixit, Pharm.D., is Postdoctoral Associate, Pharmaceutical Fellowship Program, Ernest Mario School of Pharmacy at Rutgers, State University of New Jersey (SUNJ), Piscataway; at the time of writing she was a Pharm.D. student, Ernest Mario School of Pharmacy at Rutgers, SUNJ. Youngmin Yoon, is Pharm.D. student, Ernest Mario School of Pharmacy at Rutgers, SUNJ. Lucio R. Volino, Pharm.D., is Clinical Assistant Professor, Ernest Mario School of Pharmacy at Rutgers, SUNJ, and Clinical Pharmacist, Great Atlantic and Pacific Tea Company, Kenilworth, NJ. Rupal Patel Mansukhani, Pharm.D., is Clinical Assistant Professor, Ernest Mario School of Pharmacy at Rutgers, SUNJ, and Clinical Pharmacist, Transitions of Care, Morristown Medical Center, Morristown, NJ
| | - Lucio R Volino
- Divisha Dixit, Pharm.D., is Postdoctoral Associate, Pharmaceutical Fellowship Program, Ernest Mario School of Pharmacy at Rutgers, State University of New Jersey (SUNJ), Piscataway; at the time of writing she was a Pharm.D. student, Ernest Mario School of Pharmacy at Rutgers, SUNJ. Youngmin Yoon, is Pharm.D. student, Ernest Mario School of Pharmacy at Rutgers, SUNJ. Lucio R. Volino, Pharm.D., is Clinical Assistant Professor, Ernest Mario School of Pharmacy at Rutgers, SUNJ, and Clinical Pharmacist, Great Atlantic and Pacific Tea Company, Kenilworth, NJ. Rupal Patel Mansukhani, Pharm.D., is Clinical Assistant Professor, Ernest Mario School of Pharmacy at Rutgers, SUNJ, and Clinical Pharmacist, Transitions of Care, Morristown Medical Center, Morristown, NJ
| | - Rupal Patel Mansukhani
- Divisha Dixit, Pharm.D., is Postdoctoral Associate, Pharmaceutical Fellowship Program, Ernest Mario School of Pharmacy at Rutgers, State University of New Jersey (SUNJ), Piscataway; at the time of writing she was a Pharm.D. student, Ernest Mario School of Pharmacy at Rutgers, SUNJ. Youngmin Yoon, is Pharm.D. student, Ernest Mario School of Pharmacy at Rutgers, SUNJ. Lucio R. Volino, Pharm.D., is Clinical Assistant Professor, Ernest Mario School of Pharmacy at Rutgers, SUNJ, and Clinical Pharmacist, Great Atlantic and Pacific Tea Company, Kenilworth, NJ. Rupal Patel Mansukhani, Pharm.D., is Clinical Assistant Professor, Ernest Mario School of Pharmacy at Rutgers, SUNJ, and Clinical Pharmacist, Transitions of Care, Morristown Medical Center, Morristown, NJ.
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Abstract
Oral empagliflozin (Jardiance(®)), a sodium glucose cotransporter-2 (SGLT2) inhibitor, is a convenient once-daily treatment for adult patients with type 2 diabetes mellitus. By inhibiting reabsorption of glucose from the proximal tubules in the kidney via inhibition of SGLT2, empagliflozin provides a novel insulin-independent mechanism of lowering blood glucose. In several phase III trials (≤104 weeks' duration; typically 24 weeks' duration) and extension studies (typically ≥76 weeks' treatment), empagliflozin monotherapy or add-on therapy to other antihyperglycaemics, including insulin, improved glycaemic control and reduced bodyweight and systolic blood pressure in adult patients with type 2 diabetes. In a large phase III trial, as add-on therapy to metformin, empagliflozin was shown to be noninferior to glimepiride at 52 and 104 weeks and superior to glimepiride at 104 weeks, in terms of reductions in glycated haemoglobin level (primary endpoint). Empagliflozin was well tolerated by participants in these clinical trials, with most adverse events being mild or moderate in intensity. Empagliflozin treatment appeared to have no intrinsic risk of hypoglycaemia, although hypoglycaemia occurred more frequently when empagliflozin was coadministered with insulin and/or a sulfonylurea. With its insulin-independent mechanism of action, empagliflozin monotherapy or combination therapy with other antidiabetic drugs, including insulin, provides a useful addition to the therapeutic options for the management of type 2 diabetes. This article reviews the pharmacological properties and clinical use of empagliflozin in patients with type 2 diabetes.
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Whalen K, Miller S, Onge ES. The Role of Sodium-Glucose Co-Transporter 2 Inhibitors in the Treatment of Type 2 Diabetes. Clin Ther 2015; 37:1150-66. [PMID: 25891804 DOI: 10.1016/j.clinthera.2015.03.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 03/02/2015] [Accepted: 03/05/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE Diabetes is a chronic metabolic disorder characterized by hyperglycemia that results from insulin resistance, diminished or absent insulin secretion, or both. Approximately one-half of patients with diabetes fail to achieve acceptable glycemic control. Consequently, morbidity and mortality associated with diabetes is high, resulting from complications such as cardiovascular disease and nephropathy. The sodium-glucose co-transporter 2 (SGLT2) inhibitors are a new class of medications for the treatment of type 2 diabetes. This article provides an overview of efficacy and safety data for the SGLT2 inhibitors and outlines their role in the management of diabetes. METHODS Relevant articles were identified through searches of PubMed and International Pharmaceutical Abstracts by using the key terms canagliflozin, dapagliflozin, empagliflozin, and sodium-glucose co-transporter 2 inhibitor. A review of bibliographies of retrieved articles was also performed to identify additional references. All identified trials published in English and that involved the efficacy and safety of SGLT2 inhibitors in the treatment of type 2 diabetes were reviewed. FINDINGS The SGLT2 inhibitors improve glucose control by increasing urinary glucose excretion. Effectiveness is decreased in the presence of renal dysfunction. These agents are efficacious as monotherapy and add-on therapy for patients with type 2 diabetes uncontrolled on metformin, sulfonylureas, insulin, and other antihyperglycemic combinations. The SGLT2 inhibitors lower glycosylated hemoglobin by 0.5% to 1% and fasting plasma glucose by ~15 to 35 mg/dL, depending on the agent and the dosage used, and are also associated with modest reductions in weight (-1.5 to -3.5 kg) and systolic blood pressure (-3 to -5 mm Hg). Genital mycotic infections and increased urination, owing to the mechanism of action, are the most common adverse effects. In general, the class is well tolerated, and the risk of hypoglycemia is low. IMPLICATIONS With their unique mechanism of action and good safety and tolerability profiles, the SGLT2 inhibitors are an important addition to existing treatments for type 2 diabetes. Because of the lack of data with this class of drugs when current treatment guidelines for diabetes were published, the SGLT2 inhibitors are recommended as second- or third-line therapies for diabetes. Forthcoming data on the long-term efficacy and safety profile of these agents should help to solidify the role of SGLT2 inhibitors in the management of diabetes.
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Affiliation(s)
- Karen Whalen
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida.
| | - Shannon Miller
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Orlando Campus, Orlando, Florida
| | - Erin St Onge
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Orlando Campus, Orlando, Florida
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White JR. Empagliflozin, an SGLT2 Inhibitor for the Treatment of Type 2 Diabetes Mellitus. Ann Pharmacother 2015; 49:582-98. [DOI: 10.1177/1060028015573564] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: To review available studies of empagliflozin, a sodium glucose co-transporter-2 (SGLT2) inhibitor approved in 2014 by the European Commission and the United States Food and Drug Administration for the treatment of type 2 diabetes mellitus (T2DM). Data Sources: PubMed was searched using the search terms empagliflozin, BI 10773, and BI10773, for entries between January 1, 2000, and December 1, 2014. Reference lists from retrieved articles were searched manually for additional peer-reviewed publications. Study Selection and Data Extraction: All publications reporting clinical trials of empagliflozin were eligible for inclusion. Data Synthesis: Empagliflozin is a new once-daily oral SGLT2 inhibitor with a mechanism of action that is independent of β-cell function and the insulin pathway. Data from a comprehensive phase III clinical trial program have demonstrated its efficacy as monotherapy, as add-on to other glucose-lowering agents, and in different patient populations. In these studies, empagliflozin resulted in improvements in blood glucose levels as well as reductions in body weight and blood pressure. Empagliflozin was well tolerated and was not associated with an increased risk of hypoglycemia versus placebo. Conclusion: The oral antidiabetes agent, empagliflozin, can be used as monotherapy or alongside other glucose-lowering treatments, including insulin, to treat T2DM.
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Drug-drug interactions with sodium-glucose cotransporters type 2 (SGLT2) inhibitors, new oral glucose-lowering agents for the management of type 2 diabetes mellitus. Clin Pharmacokinet 2014; 53:295-304. [PMID: 24420910 DOI: 10.1007/s40262-013-0128-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Inhibitors of sodium-glucose cotransporters type 2 (SGLT2) reduce hyperglycaemia by decreasing renal glucose threshold and thereby increasing urinary glucose excretion. They are proposed as a novel approach for the management of type 2 diabetes mellitus. They have proven their efficacy in reducing glycated haemoglobin, without inducing hypoglycaemia, as monotherapy or in combination with various other glucose-lowering agents, with the add-on value of promoting some weight loss and lowering arterial blood pressure. As they may be used concomitantly with many other drugs, we review the potential drug-drug interactions (DDIs) regarding the three leaders in the class (dapagliglozin, canagliflozin and empagliflozin). Most of the available studies were performed in healthy volunteers and have assessed the pharmacokinetic interferences with a single administration of the SGLT2 inhibitor. The exposure [assessed by peak plasma concentrations (Cmax) and area under the concentration-time curve (AUC)] to each SGLT2 inhibitor tested was not significantly influenced by the concomitant administration of other glucose-lowering agents or cardiovascular agents commonly used in patients with type 2 diabetes. Reciprocally, these medications did not influence the pharmacokinetic parameters of dapagliflozin, canagliflozin or empagliflozin. Some modest changes were not considered as clinically relevant. However, drugs that could specifically interfere with the metabolic pathways of SGLT2 inhibitors [rifampicin, inhibitors or inducers of uridine diphosphate-glucuronosyltransferase (UGT)] may result in significant changes in the exposure of SGLT2 inhibitors, as shown for dapagliflozin and canagliflozin. Potential DDIs in patients with type 2 diabetes receiving chronic treatment with an SGLT2 inhibitor deserve further attention, especially in individuals treated with several medications or in more fragile patients with hepatic and/or renal impairment.
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Pharmacokinetic drug interactions are unlikely when sodium–glucose cotransporters type 2 inhibitors are used to treat type 2 diabetes mellitus. DRUGS & THERAPY PERSPECTIVES 2014. [DOI: 10.1007/s40267-014-0147-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Neumiller JJ. Empagliflozin: a new sodium-glucose co-transporter 2 (SGLT2) inhibitor for the treatment of type 2 diabetes. Drugs Context 2014; 3:212262. [PMID: 24991224 PMCID: PMC4079288 DOI: 10.7573/dic.212262] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/28/2014] [Accepted: 03/05/2014] [Indexed: 01/09/2023] Open
Abstract
Type 2 diabetes is increasing in prevalence worldwide, and hyperglycemia is often poorly controlled despite a number of therapeutic options. Unlike previously available agents, sodium-glucose co-transporter 2 (SGLT2) inhibitors offer an insulin-independent mechanism for improving blood glucose levels, since they promote urinary glucose excretion (UGE) by inhibiting glucose reabsorption in the kidney. In addition to glucose control, SGLT2 inhibitors are associated with weight loss and blood pressure reductions, and do not increase the risk of hypoglycemia. Empagliflozin is a selective inhibitor of SGLT2, providing dose-dependent UGE increases in healthy volunteers, with up to 90 g of glucose excreted per day. It can be administered orally, and studies of people with renal or hepatic impairment indicated empagliflozin needed no dose adjustment based on pharmacokinetics. In Phase II trials in patients with type 2 diabetes, empagliflozin provided improvements in glycosylated hemoglobin (HbA1c) and other measures of glycemic control when given as monotherapy or add-on to metformin, as well as reductions in weight and systolic blood pressure. As add-on to basal insulin, empagliflozin not only improved HbA1c levels but also reduced insulin doses. Across studies, empagliflozin was generally well tolerated with a similar rate of hypoglycemia to placebo; however, patients had a slightly increased frequency of genital infections, but not urinary tract infections, versus placebo. Phase III studies have also reported a good safety profile along with significant improvements in HbA1c, weight and blood pressure, with no increased risk of hypoglycemia versus placebo. Based on available data, it appears that empagliflozin may be a useful option in a range of patients; however, clinical decisions will be better informed by the results of ongoing studies, in particular, a large cardiovascular outcome study (EMPA-REG OUTCOME™).
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Affiliation(s)
- Joshua J Neumiller
- Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane, WA, USA
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McGill JB. The SGLT2 Inhibitor Empagliflozin for the Treatment of Type 2 Diabetes Mellitus: a Bench to Bedside Review. Diabetes Ther 2014; 5:43-63. [PMID: 24729157 PMCID: PMC4065283 DOI: 10.1007/s13300-014-0063-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The treatment of type 2 diabetes mellitus (T2DM) continues to pose challenges for clinicians and patients. The dramatic rise in T2DM prevalence, which has paralleled the rise in obesity, has strained the healthcare system and prompted the search for therapies that not only effectively treat hyperglycemia, but are also weight neutral or promote weight loss. In most clinical situations after diagnosis, patients are advised to adopt lifestyle changes and metformin is initiated to help control blood glucose levels. However, metformin may not be tolerated, or may not be sufficient for those with higher glucose levels at diagnosis. Even among those who have initial success with metformin, the majority eventually require one or more additional agents to achieve their treatment goals. Because T2DM is a progressive disease, the requirement for combination treatment escalates over time, driving the need for therapies with complementary mechanisms of action. METHODS AND RESULTS Online public resources were searched using "empagliflozin", identifying 32 articles in PubMed, and 12 abstracts presented at the 2013 American Diabetes Association meeting. Peer-reviewed articles and abstracts describing preclinical studies and clinical trials were retrieved, and relevant publications included in this review. Trials registered on clinicaltrials.gov were searched for ongoing empagliflozin studies. CONCLUSION The sodium-glucose co-transporter 2 (SGLT2) inhibitors are of great interest since they provide a novel, insulin-independent mechanism of action. The SGLT2 inhibitor empagliflozin has demonstrated promising pharmacodynamic and pharmacokinetic properties. In clinical trials, empagliflozin has demonstrated a good efficacy and safety profile in a broad range of patients with T2DM, and appears to be an attractive adjunct therapeutic option for the treatment of T2DM. Ongoing trials, including patients with T2DM and comorbidities such as hypertension, are expected to provide important additional data, which will further define the role of empagliflozin in a growing movement toward individualized approaches to diabetes care.
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Affiliation(s)
- Janet B McGill
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, 660 S. Euclid, Campus Box 8127, St. Louis, MO, 63110, USA,
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Gangadharan Komala M, Mather A. Empagliflozin for the treatment of Type 2 diabetes. Expert Rev Clin Pharmacol 2014; 7:271-9. [PMID: 24716752 DOI: 10.1586/17512433.2014.908703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Diabetes and its complications account for a significant healthcare burden. There is increasing prevalence of diabetes and newer drugs are being investigated to improve outcomes. Sodium-glucose cotransporter inhibitors (SGLT2 inhibitors) are a newer class of medications, which prevent renal reabsorption of glucose and hence help in glycaemic control without significant risk of hypoglycaemia. Two drugs, namely dapagliflozin and canagliflozin have gained approval and empagliflozin is one of the advanced agents of this class. Early trials with empagliflozin have shown a stable pharmacokinetic profile and pharmacodynamic effects with significant SGLT2 selectivity. Clinical trials have shown improvement in glycaemic control and other benefits including weight loss and lowering of blood pressure. Ongoing trials and surveillance will provide answers about cardiovascular benefits, risk of osteoporosis and cancer.
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Affiliation(s)
- Muralikrishna Gangadharan Komala
- Renal Research Lab, Kolling Institute of Medical Research, Sydney University, Royal North Shore Hospital, Reserve Road, St Leonards, NSW 2065, Australia
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Scheen AJ. Pharmacokinetic and pharmacodynamic profile of empagliflozin, a sodium glucose co-transporter 2 inhibitor. Clin Pharmacokinet 2014; 53:213-225. [PMID: 24430725 PMCID: PMC3927118 DOI: 10.1007/s40262-013-0126-x] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Empagliflozin is an orally active, potent and selective inhibitor of sodium glucose co-transporter 2 (SGLT2), currently in clinical development to improve glycaemic control in adults with type 2 diabetes mellitus (T2DM). SGLT2 inhibitors, including empagliflozin, are the first pharmacological class of antidiabetes agents to target the kidney in order to remove excess glucose from the body and, thus, offer new options for T2DM management. SGLT2 inhibitors exert their effects independently of insulin. Following single and multiple oral doses (0.5-800 mg), empagliflozin was rapidly absorbed and reached peak plasma concentrations after approximately 1.33-3.0 h, before showing a biphasic decline. The mean terminal half-life ranged from 5.6 to 13.1 h in single rising-dose studies, and from 10.3 to 18.8 h in multiple-dose studies. Following multiple oral doses, increases in exposure were dose-proportional and trough concentrations remained constant after day 6, indicating a steady state had been reached. Oral clearance at steady state was similar to corresponding single-dose values, suggesting linear pharmacokinetics with respect to time. No clinically relevant alterations in pharmacokinetics were observed in mild to severe hepatic impairment, or in mild to severe renal impairment and end-stage renal disease. Clinical studies did not reveal any relevant drug-drug interactions with several other drugs commonly prescribed to patients with T2DM, including warfarin. Urinary glucose excretion (UGE) rates were higher with empagliflozin versus placebo and increased with dose, but no relevant impact on 24-h urine volume was observed. Increased UGE resulted in proportional reductions in fasting plasma glucose and mean daily glucose concentrations.
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Affiliation(s)
- André J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders and Division of Clinical Pharmacology, Department of Medicine, CHU Sart Tilman (B35), University of Liège, B-4000, Liège 1, Belgium.
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Scheen AJ. Evaluating SGLT2 inhibitors for type 2 diabetes: pharmacokinetic and toxicological considerations. Expert Opin Drug Metab Toxicol 2014; 10:647-63. [PMID: 24387329 DOI: 10.1517/17425255.2014.873788] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Inhibitors of sodium-glucose cotransporters type 2 (SGLT2), which increase urinary glucose excretion independently of insulin, are proposed as a novel approach for the management of type 2 diabetes mellitus (T2DM). AREAS COVERED An extensive literature search was performed to analyze the pharmacokinetic characteristics, toxicological issues and safety concerns of SGLT2 inhibitors in humans. This review focuses on three compounds (dapagliflozin, canagliflozin, empagliflozin) with results obtained in healthy volunteers (including drug-drug interactions), patients with T2DM (single dose and multiple doses) and special populations (those with renal or hepatic impairment). EXPERT OPINION The three pharmacological agents share an excellent oral bioavailability, long half-life allowing once-daily administration, low accumulation index and renal clearance, the absence of active metabolites and a limited propensity to drug-drug interactions. No clinically relevant changes in pharmacokinetic parameters were observed in T2DM patients or in patients with mild/moderate renal or hepatic impairment. Adverse events are a slightly increased incidence of mycotic genital and rare benign urinary infections. SGLT2 inhibitors have the potential to reduce several cardiovascular risk factors, and cardiovascular outcome trials are currently ongoing. The best positioning of SGLT2 inhibitors in the armamentarium for treating T2DM is still a matter of debate.
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Affiliation(s)
- André J Scheen
- University of Liège, Center for Interdisciplinary Research on Medicines (CIRM), CHU Sart Tilman, Division of Diabetes, Nutrition and Metabolic Disorders, Division of Clinical Pharmacology, Department of Medicine , B-4000 Liege 1 , Belgium +32 4 3667238 ; +32 4 3667068 ;
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