FORXIGA - Completely new class of diabetes medicine

AstraZeneca are releasing a new drug called Forxiga (for-zee-ga) or dapagliflozin (da-pa-glee-flo-sin). It is marketed as a medicine to treat type 2 diabetes. The difference that sets this medicine apart from current diabetes medicines is that it it's mechanism is insulin-independent.

While current diabetes medicines either augment insulin production, increase insulin sensitivity or supplement insulin directly into the body, this completely new class of diabetes medicine does not rely on the insulin pathway.

How it works:

Dapagliflozin works in the kidneys. It stops glucose from being re-absorbed and thus increasing glucose elimination. In short, it makes your urine sweet.

MOA of Forxiga

Side effects:

1. As the glucose content of the urine increases, so does the patient's chances of getting a UTI. Patient's are likely to get UTIs or other infections within 1 week of treatment. However studies showed that 1 course of appropriate treatment successfully eliminate the infection without future recurrence. However, be cautious in patients already having recurring UTIs.
2. Dapagliflozin's effect is completely renally dependant. Monitor renal function and be careful in patients with CrCl less than 60ml/min.
3. It can cause weight loss. Although unproven, the theory is that it increases sodium excretion that leads to accompanied loss of water.
   

Role in therapy: 

Dapagliflozin is designed to be used in combination with
current diabetes medicines. However not recommended with pioglitazone. 

Dosage:

10mg tablet once daily. No dose adjustments required for any demographic. One dose fits all.

When will it come out?

December 1st 2013. It will be on the PBS, but will require an Authority.

Personal comment:

Exciting and novel mechanism to treat diabetes. This opens up a new option for patients that have problems with their insulin. I'm looking forward to seeing it in practice.