Diabetes complications remain a major cause of morbidity, mortality, and economic burden on patients as well as the overall healthcare system of India. An optimal therapy at all levels of care is imperative following early diagnosis of diabetes and screening for its complications. Fortunately, effective interventions are available but unfortunately, these are not affordable to everyone.

Oral antidiabetics like SGLT2 inhibitors or gliflozins (dapagliflozin, canagliflozin, and empagliflozin) that offer benefits beyond glycemic control, such as weight loss, blood pressure reduction, cardio-, and reno-protection etc.,¹ have been around for a while. SGLT2 inhibitors like dapagliflozin boast of substantial evidence demonstrating their utility and potential in the prevention and slowing down of the progression of cardiovascular and renal complications of diabetes.

However, the cost of these medications owing to the brand monopolies in the market remains a major roadblock in disseminating their benefits to the masses. Many patients in India lack health insurance, which further exaggerates the concern, making the patients’ lives even more stressful. For many patients, this has meant either cutting back on medicines or not taking them at all, keeping them out of the purview of optimal care. The exorbitant costs of the therapy also justify the clinicians’ apprehension in prescribing costlier gliflozins to patients at large. In both cases, what suffers eventually is patient outcomes. For many physicians, this has meant switching to cheaper gliflozins like remogliflozin.

However, some dapagliflozin brands going off-patent is a silver lining to this crisis. The plunging prices of dapagliflozin following the loss of brand monopolies would give dapagliflozin an overall pharmacoeconomic edge over other gliflozins, especially remogliflozin. The low price of generic dapagliflozinhas minimized the cost to almost one fourth when compared with known brands. At these lowered prices, dapagliflozin would be even more economical than remogliflozin.

Dapagliflozin has shown its potential for the reduction of cardiovascular and renal complications in T2DM via randomized clinical trials including DECLARE TIMI, DAPA-HF, and DAPA CKD. The robust evidence has led to the approval of dapagliflozin across the world. On the other hand, remogliflozin lags in the race with evidence available largely for its effectiveness in glycemic control. This gives generic dapagliflozin a further edge in the cost-utility analysis, i.e. unlike remogliflozin, it offers more utility for prevention of adverse events like myocardial infarction/stroke, renal event, heart failure, etc.

The huge price reduction is expected to accelerate the clinical adoption of dapagliflozinon account of its cardio-and reno-protective benefits and potential to manage a greater number of patients with diabetes.

Dapagliflozin is currently approved in India as an adjunct to diet and exercise to improve glycemic control in adults with T2DM.

Reference

1. Mohan V, Mithal A, Joshi SR, et al. Remogliflozin etabonate in the treatment of type 2 diabetes: design, development, and place in therapy. Drug Des Devel Ther. 2020;14:2487-2501.