Briefing Note - vildagliptin (Galvus)

SMC has accepted vildagliptin, in combination with a commonly used drug called metformin, to treat type 2 diabetes in patients who are taking metformin at its highest dose but whose blood sugar levels are still inadequately controlled. The combination of vildagliptin and metformin should only be given to patients taking metformin who cannot be given one of a group of drugs called sulphonylureas.

• Diabetes mellitus is a condition in which there is too much sugar present in the blood. Type 2 diabetes develops when the body does not make enough insulin (a hormone which helps sugar to be used by the body) or when the insulin that is produced does not work properly. Keeping blood sugar levels as near to normal as possible reduces the risk of long-term diabetes complications such as heart disease, blindness, stroke and kidney failure.
• For many people, type 2 diabetes can be managed with diet alone. However, there are already several types of oral medicine to reduce blood sugar levels (metformin, sulphonylureas, glitazones). Vildagliptin is one of a new type of medicine (DPP-4 inhibitors) which works by blocking a particular enzyme called dipeptidyl peptidase type 4, causing an increase in blood levels of insulin and some other related hormones. It is given as an oral tablet.
• A study has shown that vildagliptin works as well as one of the glitazone drugs (both given with metformin) to control blood sugar levels.
• A side effect of drugs to treat diabetes can be weight gain, and patients treated with vildagliptin had less weight gain than those treated with a glitazone.
• SMC felt that treatment with vildagliptin and metformin would be value for money compared with other treatment options in patients with poor blood sugar control who currently take metformin on its own and who cannot be given a combination of metformin with a sulphonylurea. The manufacturer did not ask SMC to consider the use of vildagliptin in combination with other groups of anti-diabetic drug that are licensed.