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.

  1. See corresponding subsection in SmPC for additional information.
  2. 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.
  3. 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.
  4. Volume depletion includes, e.g. the predefined preferred terms: dehydration, hypovolaemia, hypotension.
  5. See section 4.4 of SmPC for more details.
  6. 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.
  7. Polyuria includes the preferred terms: pollakiuria, polyuria, urine output increased.
  8. 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.
  9. 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%.
  10. Frequency of adverse reaction was identified from the full study population in 2 placebo-controlled studies in subjects with type 1 diabetes mellitus.
  11. Reported in the cardiovascular outcomes study in patients with type 2 diabetes. Frequency is based on annual rate.
  12. * Reported in ≥2% of subjects and ≥1% more and at least 3 more subjects treated with Forxiga 10 mg compared to placebo.
  13. ** 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:

  1. Forxiga. Summary of Product Characteristics. 2019. AstraZeneca.
 

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