The drug combination of saxagliptin and dapagliflozi, marketed as Qter, will now be available within NHS Scotland for adults with type 2 diabetes.
Qter, an AstraZeneca drug, is a single pill treatment that was approved by the European Commission in July 2016 for use in people with type 2 diabetes in the UK.
The drug is indicated for those who do not have adequate blood sugar control with metformin and/or sulphonylureas after trials showed stark improvements in HbA1c levels with Qtern.
Qtern combines 5mg of a dipeptidyl peptidase-4 (DPP-4) inhibitor (saxagliptin), with 10mg of a sodium glucose co-transporter 2 (SGLT2) inhibitor (dapagliflozin).
In one study, more patients achieved a HbA1c of less than 7% (53 mmol/mol) at week 24 with Qtern and metformin (35.3%) than when given a placebo plus dapagliflozin and metformin (23.1%).
Oftentimes, patients may resort to Qtern if unsuccessfully treated with the drug’s individual components, Onglyza (saxagliptin) or Forxiga (dapagliflozin).
DPP-4 inhibitors and SGLT2 inhibitors have complementary mechanisms of action to lower blood sugars, which is why they’re paired together in Qtern.
The decision of the Scottish Medicines Consortium (SMC) to allow the use of Qtern in a number of NHS trusts will enable patients to get two medications in one at a lower cost.
In terms of Qtern’s safety profile, it is comparable in the research to the known safety profiles of saxagliptin and dapagliflozin.
The most frequently reported side effects are upper respiratory tract infections and hypoglycemia, when used with a sulphonylurea.
The drug is not recommended in patients with moderate to severe renal impairment, end-stage renal disease (ESRD) or severe hepatic impairment.
Qtern will be available for use on its own or alongside metformin for Scottish people with type 2 diabetes aged 18 years and older through GPs within locally commissioned services.
This is a welcome development for the 250,000 people with type 2 diabetes in Scotland as it provides another treatment option that can help them improve blood sugar control.
The All Wales Medicines Strategy Group (AWMSG) is in talks to have Qtern assessed and available as well through NHS Wales at local level.

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