Clinical Update for April 2017

The Ventegra® Clinical Advisory Committee (CAC) recently completed a therapeutic review on the new Federal Drug Administration (FDA)- approved lifitegrast (Xiidra®) for the treatment of signs and symptoms of dry eye disease (DED).  Lifitegrast (Xiidra®) offers a different mechanism of action compared to cyclosporine ophthalmic (Restasis®).  However, long-term efficacy and safety data is limited, and there are no head-to-head trials comparing treatment with lifitegrast to cyclosporine ophthalmic.  Both agents are similar in price and dosing schedules of twice daily.

Therapeutic Class: CAC Recommendation
Dry Eye Disease (DED)
Lifitegrast (Xiidra®) Do not add to formulary
Cyclosporine ophthalmic (Restasis®) Remain as the preferred agent on Ventegra’s Commercial formularies


At the beginning of 2017, The American Diabetic Association (ADA) and American Association of Clinical Endocrinologists/American College Endocrinology (AACE/ACE) both released updated guidelines for the treatment of diabetes. The ADA update includes the recommendation to consider using empagliflozin (Jardiance®) or liraglutide (Victoza®) in patients with cardiovascular disease, or are at high risk for developing cardiovascular disease and/or event. This recommendation is based on recent cardiovascular outcomes data available for both agents. The DPP4s currently lack clinically supported long-term cardiovascular effects.

The Ventegra CAC reviewed the DPP4s, SGLT2 inhibitors, and GLP-1 agonists in March 2017 and the following recommendations were made:

Therapeutic Class: CAC Recommendation
Diabetic Review of Newer Agents (SGLT-2 inhibitors)

Empagliflozin (Jardiance®)

Empagliflozin plus metformin (Synjardy®)

Empagliflozin plus linagliptin (Glyzambi®)

Add as a preferred SGLT2 inhibitor listed on all Ventegra Commercial formularies

Canagliflozin (Invokana®)

Canagliflozin plus metformin (Invokamet®)

Cangliflozin plus metformin SR (Invokamet® XR)

Add as a preferred SGLT2 inhibitor listed on all Ventegra Commercial formularies
Diabetic Review of Newer Agents (GLP-1)
Liraglutide (Victoza®) Remain as the preferred once daily GLP-1 agonists on Ventegra Commercial formularies
Dulaglutide (Trulicity®) Recommended as a consideration for a once weekly GLP-1
Diabetic Review of Newer Agents (DPP4s) No change was made to the DPP4 class


The ADA recognizes the non-inferiority of basal insulin plus rapid-acting insulin when compared to basal insulin plus GLP-1 or multi-dose premixed insulin. The newly FDA approved basal insulin plus GLP-1 combinations, Soliqua™ (insulin glargine/lixisenatide) and Xultophy® (insulin degludec/liraglutide) may be more cost-effective and convenient in patients requiring both a GLP-1 and basal insulin for appropriate HbA1c control. However, both agents were very recently approved, and the committee would like to wait for long-term data regarding these combinations. Metformin remains a first-line choice for the treatment of type 2 diabetes. The continual increase in the cost of insulin, and additional focus on cost-based non-insulin therapies remain significant issues in the treatment of type 2 diabetes.


Therapeutic Class: CAC Recommendation
Antidiabetic Combinations
Insulin glargine/lixisenatide (Soliqua) Do not add to Ventegra Commercial formularies
Insulin degludec/liraglutide (Xultophy®) Do not add to Ventegra Commercial formularies


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