Download Exenatide 2007

The Village Medical Centre
Gt Denham
Kingswood Way, Great Denham
Bedford, MK40 4GH
Dr. Andrew Gray
Mob: 07775693753 Fax: 01234 244025 E-Mail: [email protected]
Tel:01234 244000 Web:www.gtdenham.org
BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE
12TH SEPTEMBER 2007
I attended this Committee for the first time on behalf of Horizon at Steppingley
Hospital.
Many issues were discussed, but of the most immediate importance Clinically
and Economically was EXENATIDE (Byetta) in the management of Type 2
Diabetes.
This is from a new class of Drug with significant benefits over and above the
Glitazones and Insulin for people who fulfil the following criteria
 BMI > 30
 Hba1c > 8%
Recommended as Add-on to double therapy
May be used instead of a Glitazone with Monotherapy.
The backdrop is that Glitazones are suddenly seeming a far less favourable
option, especially in the Obese group.
There are currently significant numbers of patients attending Secondary Care in
this category where there has been considerable reluctance to initiate Insulin
therapy. It is proposed to start treatment with these.
Advantages of Exenatide over Insulin
 Standard daily dosage
 Does not cause Hypoglycaemia
 Produces a fall in BMI whereas Insulin causes a rise
 Does not require all the paraphernalia of frequent blood sugar testing
 Produces a fall in Hba1c of up to 1%
Disadvantages of Exenatide
 Twice daily s/c self injection
 Nausea which proves intolerable in possibly 40% of patients
 It is expensive £830 per pt. p.a.
The Village Medical Centre
Gt Denham
Kingswood Way, Great Denham
Bedford, MK40 4GH
Dr. Andrew Gray
Mob: 07775693753 Fax: 01234 244025 E-Mail: [email protected]
Tel:01234 244000 Web:www.gtdenham.org
Proposal
 Initiate Exenatide therapy at the Diabetic Clinic for those already attending
 Secondary Care to provide the first month of therapy only.
 Secondary Care to train Nurses and GPs
 Prescribing transferred to Primary Care while monitoring continues at
Secondary Care
 It was also proposed that ALL our patients who might benefit should be
referred to Secondary Care for change-over of treatment.
I and other GP reps opposed this last point as we believed that after a few
months of experience with prescribing for Hospital Initiated cases, and following
strict criteria for Patient Selection, the costs of Out Patient appointments for
patients currently managed in Primary Care seemed unnecessary.
We believe that within a few months, GPs with a responsibility for Diabetes could
confidently manage this case-load.
This proposal will return to the December meeting at Steppingley where I expect
it to be actioned.
I attach their Business Case and a brief account of the Drug itself.
Added benefits are that the significant efforts employed when putting Type 2s on
Insulin will be avoided, Control will be improved so improving Quality and
Outcomes, all at a modest overall increase in costs.
Andrew Gray
Other Decisions
Grazax was NOT approved for seasonal Pollen Allergy.
Champix for Smoking Cessation looks very promising, but will not be approved
until the Smoking Cessation Service has adequately trained their ‘Counsellors’ to
properly select the appropriate patients.