Diabetes

Jardiance, best in class? Maybe

The newest class of diabetes medications is called the SGLT-2.  They work by forcing the kidneys to get rid of sugar in the urine.  There are three in the class.  Jardiance, Invokana, Farxiga.

Jardiance just came out with a clinical trial that showed that it can prevent cardiovascular death by 38% in patients that have cardiovascular disease.

The Jardiance data that came out is very similar to the statin trials that came out many years ago that showed cardiovascular benefit.  Same with the ACE inhibitor trials.  All the medications within both classes are now used for prevention.  It took several trials in different medications within the class to extrapolate this, but eventually, we have extrapolated and we now see all statins and ACE inhibitors the same way.

This will probably happen to the SGLT-2 class as well.  We will look upon this years from now and feel comfortable using any of the three.

The biggest barrier is the cost.  There is no way that I will use a drug that costs $400-$500 a month for this kind of prevention.  The insurance companies will have to get on board with this data if they truely believe it and work with the pharma companies to get Jardiance covered.  Until then, it’s a class effect in my mind.

You have to look at all clinical trials with a grain of salt.  It’s a numbers game and they can either fudge the numbers or just screw up the design of the trial.  It’s rarely a perfect set up and results.

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