Jalra - vildagliptin
What is Jalra?
Jalra is a medicine that contains the active substance vildagliptin. It is available as light yellow, round tablets (50 mg).
This medicine is identical to Galvus, which is already authorized in the European Union (EU). The company that makes Galvus has agreed that its scientific data are used for Jalra.
What is Jalra used for?
Jalra is used to treat type 2 diabetes mellitus (non-insulin-dependent diabetes). It is used in combination with another antidiabetic medicine (in 'dual therapy'), when the patient's diabetes is not sufficiently controlled by this other medicine taken alone. Jalra can be used in combination with metformin, a thiazolidinedione or a sulfonylurea, but in patients who cannot take metformin it is only combined with a sulphonylurea.
The medicine can only be obtained with a prescription.
How is Jalra used?
In adult patients, the recommended dose of Jalra is:
- when combined with metformin or a thiazolidinedione, one tablet in the morning and one in the evening;
- when combined with a sulfonylurea, one tablet in the morning.
The daily dose of Jalra should not exceed two tablets (100 mg). Jalra can be taken with or without food.
The use of Jalra is not recommended in patients with moderate or severe kidney problems, including hemodialysis (blood-clearing) patients with end-stage renal disease. The use of Jalra is not recommended in patients with liver problems. . The medicine should be used with caution in patients over 75 years of age.
How does Jalra work?
Type 2 diabetes is a disease in which the pancreas does not make enough insulin to control the level of glucose (sugar) in the blood or where the body is unable to use insulin effectively. The active substance in Jalra, vildagliptin, is a dipeptidylpeptidase 4 (DPP-4) inhibitor. It works by inhibiting the breakdown of "incretin" hormones in the body. These hormones, which are released into the blood after a meal, stimulate the pancreas to produce insulin. By increasing the level of incretins in the blood, vildagliptin stimulates the pancreas to produce more insulin when the
glycemic rate is high. Vildagliptin does not work if the blood glucose concentration is low. Vildagliptin also reduces the amount of glucose produced by the liver by increasing insulin levels and reducing levels of the hormone glucagon. Together, these processes reduce the rate of glucose in the blood and help control type 2 diabetes.
How has Jalra been studied?
The effects of Jalra were first tested in experimental models before being studied in humans.
In addition, Jalra has been tested in seven main studies involving more than 4,000 patients with type 2 diabetes and insufficient blood glucose control.
Three of these studies looked at the effects of Jalra taken alone in 2,198 patients who had never been treated for diabetes, comparing it to placebo (a dummy treatment), metformin or rosiglitazone (a thiazolidinedione).
The other four studies compared the effects of Jalra, at a dose of 50 or 100 mg daily for 24 weeks, with those of placebo, used as an adjunct to existing treatment with metformin (544 patients), pioglitazone (a thiazolidinedione, 463 patients) , glimepiride (a sulphonylurea, 515 patients) or insulin (296 patients). In all of the studies, the main measure of effectiveness was the change in the blood concentration of a substance called glycosylated hemoglobin (HbA1c), which gives an "indication of how well the blood glucose is controlled."
What benefit has Jalra shown during the studies?
In all studies, Jalra reduced the level of HbA1c. Used alone, the medicine reduced HbA1c levels by approximately 1% from a starting level of approximately 8% after 24 weeks, but was less effective than metformin or rosiglitazone.
As an add-on to an existing treatment for type 2 diabetes, Jalra was more effective than placebo at lowering HbA1c levels. The daily dose of 100 mg, in combination with metformin and pioglitazone, was more effective than the 50 mg dose, resulting in a reduction in HbA1c levels of between 0.8% and 1.0%. In combination with glimepiride , both daily doses of 50 and 100 mg resulted in a reduction of approximately 0.6%. In contrast, more modest changes in HbA1c level, ranging from a decrease of 0 to 0, were observed in patients who added placebo to existing treatment. , 3% and an increase of 0.2%.
Although adding Jalra to existing insulin therapy resulted in a greater reduction in HbA1c levels than placebo, the extent of this effect was too small to be considered significant for patients.
During the evaluation of the medicine, the company withdrew its application for authorization for the use of Jalra alone and as an adjunct to insulin therapy.
What is the risk associated with Jalra?
The most common side effect with Jalra (seen in between 1 and 10 patients in 100) is dizziness. For the full list of side effects reported with Jalra, see the package leaflet.
Jalra must not be used in people who may be hypersensitive (allergic) to vildagliptin or any of the other substances. Use in heart disease patients should be limited to those with mild disease.
Since vildagliptin has been associated with liver problems, patients should have liver tests before taking Jalra and at regular intervals during treatment.
Why has Jalra been approved?
The Committee for Medicinal Products for Human Use (CHMP) concluded that Jalra's benefits are greater than its risks for the treatment of type 2 diabetes mellitus when used as dual oral therapy in combination with metformin, a sulphonylurea or a thiazolidinedione. The committee recommended the granting of a marketing authorization for Jalra.
Other information about Jalra:
On November 19, 2008, the European Commission granted Novartis Europharm Limited a "Marketing Authorization" for Jalra, valid throughout the European Union.
For the full version of Jalra's EPAR, click here.
Last update of this summary: 10-2008.
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