Janssen-Cilag launched canagliflozin in March for use as monotherapy or in combination with other hypoglycaemics and/or insulin when the existing regimen, in combination with diet and exercise changes, provides inadequate glycaemic control.
The guidance accepts canagliflozin for use in combination with metformin when sulfonylureas are contraindicated or not tolerated or if the patient is at significant risk of hypoglycaemia or its consequences. The SGLT2 inhibitor is also recommended as an option for combination therapy with insulin, with or without other hypoglycaemics.
In addition, canagliflozin can be used on the NHS in a triple oral therapy regimen with metformin plus either a sulfonylurea or a thiazolidinedione ('glitazone'). This differs from the NICE recommendations for dapagliflozin published in June 2013, where the regulatory body rejected dapagliflozin for use in triple oral regimens.
A fixed-dose combination tablet containing canagliflozin and metformin has been approved in the EU but has not yet been launched in the UK.