FORXIGA WAS GENERALLY WELL TOLERATED IN TYPE 1 DIABETES (T1D) PATIENTS1
The most frequently reported adverse reactions associated with Forxiga 5 mg in patients with T1D were genital infections, which were more frequent in females. Diabetic ketoacidosis (DKA) was reported with common frequency.1
Adverse reactions in placebo-controlled clinical studies and post-marketing experience1
System organ class | Very common | Common* | Uncommon** | Rare | Very rare |
---|---|---|---|---|---|
Infections and infestations | Vulvovaginitis, balanitis and related genital infectionsa,b* Urinary tract infectiona,c* | Fungal infection** | Necrotising fasciitis of the perineum (Fournier's gangrene)a,e | ||
Metabolism and nutrition disorders | Hypoglycaemia (when used with SU or insulin)a | Diabetes ketoacidosis (when used in type 2 diabetes mellitus)a,e,j | Volume depletiona,d Thirst** | Diabetes ketoacidosis (when used in type 1 diabetes mellitus)a,e,k | |
Nervous system disorders | Dizziness | ||||
Gastrointestinal disorders | Constipation** Dry mouth** | ||||
Skin and subcutaneous tissue disorders | Rashf | Angioedema | |||
Musculoskeletal and connective tissue disorders | Back pain* | ||||
Renal and urinary disorders | Dysuria Polyuriag* |
Nocturia** | |||
Reproductive system and breast disorders | Vulvovaginal pruritus** Pruritus genital** | ||||
Investigations | Haematocrit increasedh Creatinine renal clearance decreased during initial treatmenta Dyslipidaemiai | Blood creatinine increased during initial treatment a** Blood urea increased** Weight decreased** |
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The table shows up to 24-week (short-term) data regardless of glycaemic rescue.
- See corresponding subsection in SmPC for additional information.
- Vulvovaginitis, balanitis and related genital infections includes, e.g. the predefined preferred terms: vulvovaginal mycotic infection, vaginal infection, balanitis, genital infection fungal, vulvovaginal candidiasis, vulvovaginitis, balanitis candida, genital candidiasis, genital infection, genital infection male, penile infection, vulvitis, vaginitis bacterial, vulval abscess.
- Urinary tract infection includes the following preferred terms, listed in order of frequency reported: urinary tract infection, cystitis, Escherichia urinary tract infection, genitourinary tract infection, pyelonephritis, trigonitis, urethritis, kidney infection and prostatitis.
- Volume depletion includes, e.g. the predefined preferred terms: dehydration, hypovolaemia, hypotension.
- See section 4.4 of SmPC for more details.
- Adverse reaction was identified through postmarketing surveillance. Rash includes the following preferred terms, listed in order of frequency in clinical trials: rash, rash generalised, rash pruritic, rash macular, rash maculo-papular, rash pustular, rash vesicular, and rash erythematous. In active- and placebo-controlled clinical trials (Forxiga, N=5,936, all control, N=3,403), the frequency of rash was similar for Forxiga (1.4%) and all control (1.4%), respectively.
- Polyuria includes the preferred terms: pollakiuria, polyuria, urine output increased.
- Mean changes from baseline in haematocrit were 2.30% for Forxiga 10 mg versus -0.33% for placebo. Haematocrit values >55% were reported in 1.3% of the subjects treated with Forxiga 10 mg versus 0.4% of placebo subjects.
- Mean percent change from baseline for Forxiga 10 mg versus placebo, respectively, was: total cholesterol 2.5% versus 0.0%; HDL cholesterol 6.0% versus 2.7%; LDL cholesterol 2.9% versus -1.0%; triglycerides -2.7% versus -0.7%.
- Frequency of adverse reaction was identified from the full study population in 2 placebo-controlled studies in subjects with type 1 diabetes mellitus.
- Reported in the cardiovascular outcomes study in patients with type 2 diabetes. Frequency is based on annual rate.
- * Reported in ≥2% of subjects and ≥1% more and at least 3 more subjects treated with Forxiga 10 mg compared to placebo.
- ** Reported by the investigator as possibly related, probably related or related to study treatment and reported in ≥0.2% of subjects and ≥0.1% more and at least 3 more subjects treated with Forxiga 10 mg compared to placebo.
LDL, low-density lipoprotein; HDL, high-density lipoprotein; SU, sufonylurea.
Frequency categories are defined according to the following convention: very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000), very rare (<1/10,000), and not known (cannot be estimated from the available data).
See full Summary of Product Characteristics SmPC for additional details regarding adverse reactions.
BEFORE INITIATING FORXIGA, PATIENTS SHOULD BE EVALUATED FOR THE POTENTIAL RISK OF DKA1
Factors that put patients at an increased DKA risk:
- Suboptimal insulin dose or low insulin needs
- Insulin non-compliance and dosing errors
- Increased insulin requirements due to acute medical illness or surgery
- Caloric and carbohydrate diet restrictions (e.g., the ketogenic diet)
- Recent or recurrent history of DKA
- Excessive alcohol consumption or illicit drug use
- Inexperience with insulin pump usage and recurrent problems with the device
In order to minimise the risk of DKA, key activities need to be conducted before initiating, and during, treatment with Forxiga. See sections 4.2 and 4.4 of the Summary of Product Characteristics.
BEFORE INITIATING FORXIGA:
Consider planning an education session to inform patients about:
- the risk of DKA
- how to recognise risk factors
- signs or symptoms
- how and when to monitor ketone levels
- what action to take following elevated ketone readings
Insulin pump failure and missed insulin doses were the most frequent risk factors for definite DKA in the DEPICT studies.
Treatment with Forxiga 5 mg is to be initiated and supervised by specialists in T1D.
Important safety information for healthcare professionals to minimise the risk of DKA can be found in the Risk Minimisation Materials. Available below:
RISK MINIMISATION MATERIALS
Country | HCP materials | Patient materials |
---|---|---|
Austria | VIEW | VIEW |
Belgium Dutch | VIEW | VIEW |
Belgium French | VIEW | VIEW |
Belgium German | Not applicable | VIEW |
Bulgaria | VIEW | VIEW |
Croatia | VIEW | VIEW |
Cyprus | Forxiga is not currently available for T1D | |
Czech Republic | VIEW | VIEW |
Denmark | VIEW | VIEW |
Estonia | VIEW | VIEW |
Finland Finnish | VIEW | VIEW |
Finland Swedish | VIEW | VIEW |
Germany | VIEW | VIEW |
Greece | Please contact AstraZeneca Medical Information & Patient Safety department in Greece for materials via phone by calling +30 210 6871 500 | |
Hungary | VIEW | VIEW |
Iceland | VIEW | VIEW |
Ireland | VIEW | VIEW |
Italy | VIEW | VIEW |
Latvia | VIEW | VIEW |
Lithuania | VIEW | VIEW |
Luxemburg | VIEW | VIEW |
Malta | VIEW | VIEW |
Netherlands | VIEW | VIEW |
Norway | VIEW | VIEW |
Poland | VIEW | VIEW |
Portugal | Forxiga is not currently available for T1D | |
Romania | VIEW | VIEW |
Slovakia | Forxiga is not currently available for T1D (i.e. 5 mg dose) | |
Slovenia | Forxiga is not currently available for T1D | |
Spain | Forxiga is not currently available for T1D | |
Sweden | VIEW | VIEW |
References:
- Forxiga. Summary of Product Characteristics. 2019. AstraZeneca.