Comparative analysis of therapeutic efficiency and costs (experience in Bulgaria) of oral antidiabetic therapies based on glitazones and gliptins.
Type 2 diabetes mellitus is a serious, chronic, progressive and widespread disease. Metformin is the most commonly prescribed initial therapy, but combination with other antidiabetic agents usually becomes necessary due to the progression of the disease. Pioglitazone is recommended as a second-line therapy because of its strong antihyperglycemic effect and its ability to reduce insulin resistance. Treatment with pioglitazone is associated with a significantly lower risk of cardiovascular complications and hypoglycemia, while simultaneously improving the lipid profile and the symptomatic and histological changes in the liver. Gliptins (sitagliptin and vildagliptin) are a new class of oral antidiabetic drugs which reduce glycated hemoglobin by a different mechanism. Although the efficacy of sitagliptin and vildagliptin is close to that of pioglitazone, the lack of long-term safety data and the higher price question their predominant use. The objective of this review is to highlight the advantages of mono- and combination therapy with pioglitazone in comparison with gliptins and to underline the inconsistencies in the medicinal and reimbursement policy in Bulgaria.
Science Department, Tchaikapharma High Quality Medicines, Inc, 1 G.M. Dimitrov Blvd, 1172 Sofia, Bulgaria.
Elena Pavlova
EP
Filipova
Science Department, Tchaikapharma High Quality Medicines, Inc, 1 G.M. Dimitrov Blvd, 1172 Sofia, Bulgaria.
Katya Hristova
KH
Uzunova
Department of Medical ethics, management of health care and information technology, Medical University, Pleven, Bulgaria.
Toni Yonkov
TY
Vekov
Efficiency; Gliptins; Pioglitazone; Safety; Type 2 diabetes