Linagliptin rejected by the NHS in Wales for use in type 2 diabetes due to lack of evidence of efficacy

A pen ticking off a checklist

We previously reported systematic reviews of DPP-4 inhibitors.  Recently, the All Wales Medicines Strategy Group, the government agency charged with assessing the effectiveness of medicines and making recommendations about their use in the NHS in Wales, issued an evaluation of linagliptin, a DPP-4 inhibitor marketed under the brand name Trajenta.

Clinical question:

In patients with type 2 diabetes inadequately controlled on metformin alone or who cannot take metformin, is linagliptin a cost-effective option for improving glycaemic control?

The evidence:

The review cites evidence submitted by the manufacturer.  This comprised two Phase III trials, indirect comparisons with other treatment modalities, a cost-minimisation analysis and cost data.

This evidence was critiqued by the Group, who considered that it was “insufficiently robust” for them to recommend routine use of linagliptin in this context.

A detailed breakdown of the evidence and its critique is provided.

Appraisal hints:

  • The website does not provide detailed information about the methods of the review.
  • Does this recommendation conform to AGREE principles?
  • The judgment was made due to unfavourable direct cost comparison with alternative second-line therapies, particularly combination therapy of sitagliptin with metformin in a single capsule.


All Wales Medicines Strategy Group.  Final Appraisal Recommendation, Advice No: 0112; Linagliptin (Trajenta®), Feburary 2012

You can download the full text of the assessment as a PDF or read the DARE abstract.


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I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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