Insulin glargine with lixisenatide
Type 2 diabetes mellitus [in combination with metformin]
Recommendation: BLACK RAG rating
• None of the studies in the study program for insulin glargine /lixisenatide compare the combination preparation with GLP 1 receptor agonists and basal insulins given together but as separate injections. LixiLan‑O compared insulin glargine/lixisenatide with insulin glargine alone and lixisenatide alone.
• Insulin glargine / lixisenatide (Suliqua®▼) does not currently fit into any locally or nationally defined pathways.
• Switch from GLP‑1 receptor agonist to GLP‑1 receptor agonist plus insulin combination has not been studied.
• Suliqua®▼ has not been studied in combination with DPP‑4 inhibitors, sulfonylureas, meglitinides, pioglitazone and SGLT‑2 inhibitors.
• The NICE Guidelines for the management of T2DM state the following, “only offer a glucagonlike peptide‑1 (GLP‑1) analogue in combination with insulin in a specialist care setting”
• Insulin glargine plus lixisenatide, with its fixed ratio dosing, offers less flexibility to titrate the individual components and manage interruption of treatment, and at the initiation of treatment does not allow the prescriber to understand how the patient responds to or tolerates each component.
• Potential for medication errors with two pen types / doses
Reason for decision:
Not recommended for prescribing on the NHS in Lancashire & South Cumbria