sitagliptin plus metformin (Janumet 50/1000)

following an abbreviated submission

sitagliptin plus metformin (Janumet 50/1000): is accepted for use within NHS Scotland.

Licensed indication under review: In combination with a sulphonylurea (i.e., triple combination therapy) as an adjunct to diet and exercise in patients inadequately controlled on their maximal tolerated dose of metformin and a sulphonylurea.

For patients in whom triple combination therapy with metformin, a sulphonylurea and sitagliptin is appropriate it has the potential to reduce the pill burden at no additional cost.  

When added to a sulphonylurea with metformin, sitagliptin has shown a modest effect on glycated haemoglobin (HbA1c) levels.  Note that a lower dose of the sulphonylurea may be required to reduce the risk of hypoglycaemia.

Sitagliptin/metformin is also licensed for use in triple combination therapy with a thiazolidinedione or as add-on to insulin.  The manufacturer’s submission related only to the use of sitagliptin/metformin in combination with a sulphonylurea, therefore SMC cannot recommend the use of sitagliptin/metformin in triple therapy with either a thiazolidinedione or insulin.