Committee for Medicinal Products for Human Use ( CHMP ) of the European Medicines Agency ( EMA ) has recommended approval of a single-pill combination therapy with Empagliflozin / Metformin hydrochloride ( HCl ) ( Sjnjardy ) for the treatment of adults with type 2 diabetes mellitus ( T2DM ).

Empagliflozin / metformin HCl combines within a single tablet the sodium glucose cotransporter 2 ( SGLT2 ) inhibitor, Empagliflozin ( the active ingredient in Jardiance tablets, already approved in the European Union ) and Metformin HCl, which is commonly prescribed for the treatment of type 2 diabetes mellitus.

The CHMP has recommended approval of the single-pill combination therapy for use alongside diet and exercise to improve blood glucose control in adults with type 2 diabetes mellitus when they are: a) inadequately controlled with Metformin alone or in combination with other blood glucose-lowering drugs; b) already being treated with the combination of Empagliflozin and Metformin as separate tablets.

The positive opinion is based on the submission of clinical data from seven phase III clinical trials that enrolled over 4,500 patients with type 2 diabetes mellitus.
These studies investigated the efficacy and safety data of Empagliflozin plus Metformin either alone or in combination with other blood glucose-lowering drugs ( Pioglitazone, sulfonylurea, DPP-4 inhibitors and Insulin ).

The results have shown that treatment with Empagliflozin ( 10mg and 25mg ) when added to Metformin, with or without other standard blood glucose-lowering drugs, led to statistically significant reductions in blood glucose, body weight and a clinically relevant reduction in blood pressure.

The most common side effect reported by patients in the clinical trials was hypoglycaemia in combination with Insulin and/or sulphonylurea.
In general, the adverse event profile of Empagliflozin plus Metformin HCl was in line with the known safety profile of the individual compounds Empagliflozin and Metformin.

The common side effects experienced with empagliflozin are urinary tract and genital yeast infections, increased urination and itching.
The common side effects experienced with Metformin are nausea, vomiting, diarrhoea, abdominal pain, loss of appetite and taste disturbance.

Empagliflozin plus Metformin HCl is not intended to be used in patients with type 1 diabetes mellitus or for diabetic ketoacidosis.

Empagliflozin plus Metformin HCl is expected to be available in the following twice-daily doses in Europe: 5mg Empagliflozin plus 850mg or 1000mg Metformin HCl; 12.5mg Empagliflozin plus 850mg or 1000mg Metformin HCl. ( Xagena )

Source: Boehringer Ingelheim, 2015

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