Janumet (metformin and sitagliptin)
Janumet (metformin and sitagliptin) is a new combination drug for treatment of type 2 diabetes. The drug is dosed as 50 mg sitagliptin + 850 – 1000 mg metformin.
Two double blinded, randomized and placebo controlled studies (n = 190 and 1,091) show that a combination of sitagliptin and metformin reduces HbA1c (p < 0,001) better than the drugs separately. Furthermore the ability of sitagliptin to lower HbA1c in combination with metformin and a sulfonylamide (SA) was studied in a randomized, double blinded and placebo-controlled study. The triple combinations ability in lowering HbA1c value was statisticly significant better than in the metformin + SA combination (p < 0,001).
Side effects consisting of abdominal pain, diarrhea and somnolence occurred in few patients. However is the incidence of nausea 1 – 10 %.
At the present moment there are no comparative studies with SA or the other marketed DPP-4 inhibitor vildagliptine. This would otherwise have been clinical relevant.
Janumet costs 14,23 Dkr./ DDD, while the other combination of DPP-4 inhibitor and metformin Eucreas (vildagliptin and metformin) costs 17-18 Dkr. / DDD. In comparison the most expensive combination of SA and metformin cost 5,91 Dkr./DDD.
IRF states that because of the lack of comparative studies with metformin and SA and the relative price difference Janumet should only be used in patients that can not achieve adequate glycaemic control or experiences hypoglycaemic incidences with the combination of metformin and SA.
Janumet is sold on prescription only, and is under the rules of general reimbursement.
Janumet was marketed the 11th of August 2008.