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Kalra S, Das AK, Priya G, Ghosh S, Mehrotra RN, Das S, Shah P, Bajaj S, Deshmukh V, Sanyal D, Chandrasekaran S, Khandelwal D, Joshi A, Nair T, Eliana F, Permana H, Fariduddin MD, Shrestha PK, Shrestha D, Kahandawa S, Sumanathilaka M, Shaheed A, Rahim AA, Orabi A, Al-Ani A, Hussein W, Kumar D, Shaikh K. Fixed-dose combination in management of type 2 diabetes mellitus: Expert opinion from an international panel. J Family Med Prim Care 2020; 9:5450-5457. [PMID: 33532378 PMCID: PMC7842427 DOI: 10.4103/jfmpc.jfmpc_843_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/14/2020] [Accepted: 08/03/2020] [Indexed: 01/08/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a progressive disease with multifactorial etiology. The first-line therapy includes monotherapy (with metformin), which often fails to provide effective glycemic control, necessitating the addition of add-on therapy. In this regard, multiple single-dose agents formulated as a single-dose form called fixed-dose combinations (FDCs) have been evaluated for their safety, efficacy, and tolerability. The primary objective of this review is to develop practice-based expert group opinion on the current status and the causes of concern regarding the irrational use of FDCs, in Indian settings. After due discussions, the expert group analyzed the results from several clinical evidence in which various fixed combinations were used in T2DM management. The panel opined that FDCs (double or triple) improve patient adherence, reduce cost, and provide effective glycemic control and, thereby, play an important role in the management of T2DM. The expert group strongly recommended that the irrational metformin FDC's, banned by Indian government, should be stopped and could be achieved through active participation from the government, regulatory bodies, and health ministry, and through continuous education of primary care physicians and pharmacists. In T2DM management, FDCs play a crucial role in achieving glycemic targets effectively. However, understanding the difference between rational and irrational FDC combinations is necessary from the safety, efficacy, and tolerability perspective. In this regard, primary care physicians will have to use a multistep approach so that they can take informed decisions.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
| | - A K Das
- Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - G Priya
- Department of Endocrinology, Fortis Hospital, Mohali, India
| | - S Ghosh
- Department of Endocrinology and Metabolism, IPGMER, Kolkata, West Bengal, India
| | - R N Mehrotra
- Department of Endocrinology, Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India
| | - S Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - P Shah
- Department of Endocrinology and Diabetes Gujarat Endocrine Centre, Ahmedabad, Gujarat, India
| | - S Bajaj
- Department of Endocrinology, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - V Deshmukh
- Department of Endocrinology, Deshmukh Clinic and Research Centre, Pune, Maharashtra, India
| | - D Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, West Bengal, India
| | - S Chandrasekaran
- Department of Endocrinology and Diabetes, Dr. Rela Institute of Medical Science (RIMC), Chennai, Tamil Nadu, India
| | - D Khandelwal
- Department of Endocrinology and Diabetes, Maharaja Agrasen Hospital, New Delhi, India
| | - A Joshi
- Department of Endocrinology, Kathmandu Diabetes and Thyroid Centre, Nepal
| | - T Nair
- Department of Cardiology, PRS Hospital, Trivandrum, Kerala, India
| | - F Eliana
- Department of Internal Medicine, Faculty of Medicine, YARSI University, Jakarta, Indonesia
| | - H Permana
- Department of Internal Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - M D Fariduddin
- Department of Endocrinology of Bangabandhu Sheikh, Mujib Medical University, Dhaka, Bangladesh
| | - P K Shrestha
- Department of Internal Medicine, Tribhuwan University Teaching Hospital, Kathmandu, Nepal
| | - D Shrestha
- Department of Endocrinologist, Norvic International Hospital, Kathmandu, Nepal
| | - S Kahandawa
- Department of Endocrinology, Teaching Hospital Karapitiya, Galle, Sri Lanka
| | - M Sumanathilaka
- Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - A Shaheed
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | - A A Rahim
- Department of Diabetes and Metabolism, Alexandria University, Alexandria, Egypt
| | - A Orabi
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - A Al-Ani
- Department of Internal Medicine, Hamad Hospital, Doha, Qatar
| | - W Hussein
- Department of Endocrinology and Diabetes, Dr. Wiam Clinic, Royal Hospital, Awali Hospital, Bahrain
| | - D Kumar
- Department of Endocrinology, NMC Specialty Hospital, Abu Dhabi, UAE
| | - K Shaikh
- Department of Diabetes, Faculty of Internal Medicine, Royal Oman Police Hospital, Muscat, Oman
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Kalra S, Ghosh S, Das AK, Nair T, Bajaj S, Priya G, Mehrotra RN, Das S, Shah P, Deshmukh V, Chawla M, Sanyal D, Chandrasekaran S, Khandelwal D, Joshi A, Eliana F, Permana H, Fariduddin MD, Shrestha PK, Shrestha D, Kahandawa S, Sumanathilaka M, Shaheed A, Rahim AA, Orabi A, Al-Ani A, Hussein W, Kumar D, Shaikh K. Unravelling the utility of modern sulfonylureas from cardiovascular outcome trials and landmark trials: expert opinion from an international panel. Indian Heart J 2020; 72:7-13. [PMID: 32423565 PMCID: PMC7231843 DOI: 10.1016/j.ihj.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/25/2019] [Accepted: 01/05/2020] [Indexed: 12/13/2022] Open
Abstract
AIM The primary objective of this review is to develop practice-based expert group opinions on the cardiovascular (CV) safety and utility of modern sulfonylureas (SUs) in cardiovascular outcome trials (CVOTs). BACKGROUND The United States Food and Drug Administration issued new guidance to the pharmaceutical industry in 2008 regarding the development of new antihyperglycemic drugs. The guidance expanded the scope for the approval of novel antihyperglycemic drugs by mandating CVOTs for safety. A few long-term CVOTs on dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter 2 inhibitors have been completed, while others are ongoing. SUs, which constitute one of the key antihyperglycemic agents used for the management of type 2 diabetes mellitus (T2DM), have been used as comparator agents in several CVOTs. However, the need for CVOTs on modern SUs remains debatable. In this context, a multinational group of endocrinologists convened for a meeting and discussed the need for CVOTs of modern SUs to evaluate their utility in the management of patients with T2DM. At the meeting, CVOTs of modern SUs conducted to date and the hypotheses derived from the results of these trials were discussed. REVIEW RESULTS The expert group analyzed the key trials emphasizing the CV safety of modern SUs and also reviewed the results of various CVOTs in which modern SUs were used as comparators. Based on literature evidence and individual clinical insights, the expert group opined that modern SUs are cardiosafe and that since they have been used as comparators in other CVOTs, CVOTs of SUs are not required. CONCLUSION Modern SUs can be considered a cardiosafe option for the management of patients with diabetes mellitus and CV disease; thus CVOTs among individuals with T2DM are not required.
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Affiliation(s)
- S Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India.
| | - S Ghosh
- Department of Endocrinology and Metabolism, IPGMER, Kolkata, West Bengal, India
| | - A K Das
- Department of Endocrinology & Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - T Nair
- Dept. of Cardiology, PRS Hospital, Trivandrum, Kerala, India
| | - S Bajaj
- Department of Endocrinology, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - G Priya
- Department of Endocrinology, Fortis Hospital, Chandigarh, Punjab, India
| | - R N Mehrotra
- Department of Endocrinology, Apollo Hospitals, Jubilee Hills, Hyderabad, India
| | - S Das
- Department of Endocrinology, Apollo Hospitals in Bhubaneswar, India
| | - P Shah
- Department of Endocrinology and Diabetes Gujarat Endocrine Centre, Ahmedabad, India
| | - V Deshmukh
- Department of Endocrinology, Deshmukh Clinic and Research Centre, Pune, Maharashtra
| | - M Chawla
- Department of Diabetology, Lina Diabetes Care and Mumbai Diabetes Research Centre, Mumbai, India
| | - D Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, West Bengal
| | - S Chandrasekaran
- Department of Endocrinology & Diabetes, Dr. Rela Institute of Medical Science (RIMC), Chennai, Tamil Nadu, India
| | - D Khandelwal
- Department of Endocrinology & Diabetes, Maharaja Agrasen Hospital, New Delhi, India
| | - A Joshi
- Department of Endocrinology & Diabetes, Bhaktivedanta Hospital and Research Institute, Mumbai, India
| | - F Eliana
- Department of Internal Medicine, Faculty of Medicine, YARSI University, Jakarta, Indonesia
| | - H Permana
- Department of Internal Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - M D Fariduddin
- Department of Endocrinology of Bangabandhu Sheikh, Mujib Medical University, Dhaka, Bangladesh
| | - P K Shrestha
- Department of Internal Medicine, Tribhuwan University Teaching Hospital, Kathmandu, Nepal
| | - D Shrestha
- Department of Endocrinologist, Norvic International Hospital Kathmandu, Nepal
| | - S Kahandawa
- Department of Endocrinology, Teaching Hospital Karapitiya, Sri Lanka
| | - M Sumanathilaka
- Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - A Shaheed
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | - A A Rahim
- Department of Diabetes and Metabolism, Alexandria University, Alexandria, Egypt
| | - A Orabi
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - A Al-Ani
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - W Hussein
- Department of Endocrinology & Diabetes, Royal Hospital, Bahrain
| | - D Kumar
- Department of Endocrinology, NMC Specialty Hospital, Abu Dhabi
| | - K Shaikh
- Department of Diabetes, Faculty of Internal Medicine, Royal Oman Police Hospital, Muscat, Oman
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