The Regional Drug and Therapeutics Centre has produced New Drug Evaluations for sitagliptin (Januvia®) and vildagliptin (Galvus®).
The evaluation of sitagliptin recommends that this drug "may be considered as an option for patients who fail to achieve glycaemic control despite an adequate trial of established first and second-line regimens". It also notes that long term safety and efficacy data are lacking.
The evaluation for vildagliptin makes the same recommendations and qualifies that an "appropriate place in treatment protocols is presently undetermined".
The gliptins are a new drug class with data to support statistically significant improvements in HbA1c. However, long term efficacy and safety are unknown and there are no data to demonstrate improvements in morbidity and mortality.
Action: The limitations above currently place these drugs as a last line option before moving to insulin in patients who have poor glycaemic control on established treatments or who are intolerant to established agents.