Acarbose: AVAILABILITY AND COST(1)

Prandase tablets contain 50 mg or 100 mg of acarbose packaged in blister packs, in cartons of 120 tablets. Cost of 50 mg tablets is CDN$27.11/120 tablets; cost of 100 mg tablets is CDN$37.48/120 tablets (Table 2). High quality medications available at best pharmacy that will make sure you are comfortable and secure when buying Generic Claritin or any other medicine that you need at any point.

 

 

TABLE 2 Comparison of costs of treatment with oral antidiabetic agents

Drug Usual dose/day Approximate cost (CDN$) per month*
Acarbose 150 to 300 mg $20 to $28
Metformin 1.7 g (850 mg bid) $17
Metformin1 1.5 g (500 mg tid) $12
Acetohexamide 1.0 g $25
Gliclazide 160 mg $24
Glyburide1 7.5 mg $4
Tolbutamide1 1.5 g $3
Chlorpropamide1 250 mg $2

*Cost based on Ontario Drug Benefit Formulary or wholesaler prices; fDenotes generic product

EFFICACY IN CLINICAL TRIALS

Efficacy data for acarbose can be derived from controlled clinical trials and a recently published postmarketing surveillance study conducted by Bayer in Germany. Many clinical trials with acarbose were conducted in Europe, beginning in the late 1970s (and appeared during the 1980s in publications not available for review by this author). The findings of these studies, as described here, are based on three reviews of acarbose efficacy.

The effects of acarbose on the major indexes of glycemic control (glycated hemoglobin [HbA1c] and fasting [FPG] and postprandial plasma glucose [PPG]) during clinical trials are illustrated in Tables 3 to 6.

TABLE 3 Efficacy of acarbose versus placebo in diet-treated noninsulin-dependent diabetes mellitus patients

Reference Study duration (± design) # patients Treatment and daily dose* Results (change from baseline)^HbAic (%) PPG (mmol/L) FPG (mmol/L)
20 6 months 18 Placebo -0.4 -0.2 -0.1
19 Acarbose 300 mg -1.0 -2.5 -0.6
12 6 months 47 Placebo -0.08 -0.6 -0.6
47 Acarbose 300 mg -0.57 -2.8 -0.8
16 6 months 98 Placebo +0.53 +1.1 +0.6
91 Acarbose 150 to 900 mg -0.59 -2.8 -0.9
19 4 months 64 Placebo +0.33 +1.7 +1.1
58 Acarbose 300 mg -0.78 -4.1 -1.5
54 Acarbose 600 mg -0.73 -4.6 -2.2
53 Acarbose 900 mg -1.10 -7.1 -2.0
8 12 months 37 Placebo NA NA NA
30 Acarbose 150 to 600 mg -0.9 -4.5 -2.1
211 3 months (crossover) 90 Placebo +0.2 NA -0.2
total Acarbose 150 to 300 mg -0.5 -2.4 -0.1

*Where the acarbose daily dose is designated as a range, treatment was initiated at the low dose and escalated to the maximum dose according to the protocol; fValues quoted for changes in glycemic parameters associated with drug treatments are ‘placebo-subtracted’ – for example, if the placebo group’s postprandial plasma glucose (PPG) fell 0.5 mmol/L and that of the acarbose group fell 1.5 mmol/L, then the net treatment effect will be quoted as -1.0; *Data as reported in the review by reference 4. FPG Fasting plasma glucose; HbAic Glycohemoglobin; NA Not available

TABLE 4 Comparative efficacy of acarbose versus a sulphonylurea in diet-treated patients with noninsulin-dependent diabetes mellitus

Reference Study duration (± design) # patients Treatment and daily dose Results (change from baseline)*HbAic (%) PPG (mmol/L) FPG (mmol/L)
11 6 months 30 Placebo +0.11 +0.1 +0.1
28 Acarbose 300 mg -1.11 -2.2 -1.5
27 Glyburide 4.3 mg (average) -0.91 -1.8 -1.7
22 6 months 62 Placebo +0.04 -0.7 +0.1
67 Acarbose 600 mg -0.58 -3.5 -1.2
66 Tolbutamide 750 mg -0.97 -3.9 -2.1
241 6 months (nonblinded) 26 Acarbose 300 mg -2.3 -2.6 -1.9
29 Glyburide 3.5-10.5 mg -2.3 -3.2 -2.0
231 6 months (nonblinded) 48 Acarbose 300 mg -3.2 NA -1.7
47 Glyburide 3.5-10 mg -3.2 NA -1.7

*Values quoted for changes in glycemic parameters associated with drug treatments are ‘placebo-subtracted’ – for example, if the placebo group’s postprandial plasma glucose (PPG) fell 0.5 mmol/L and that of the acarbose group fell 1.5 mmo/L, then the net treatment effect will be quoted as-1.0; fData as reported in the review by reference 4. FPG Fasting plasma glucose; HbA1c Glycohemoglobin; NA Not available

 

TABLE 5 Efficacy of acarbose in combination with other antidiabetic agents in noninsulin-dependent diabetes mellitus

Reference Study duration (± design) Previous treatment #patients Additional treatment and daily dose* Results (change from baseline)^ HbAic (%) PPG (mmol/L) FPG (mmol/L)
22 6 months Diet 62 Placebo +0.04 -0.7 -0.1
67 Acarbose 600 mg -0.58 -3.5 -1.2
66 Tolbutamide 750 mg -0.97 -3.9 -2.1
60 Acarbose 600 mg + tolbutamide 750 mg -1.36 -5.2 -2.5
8 12 months Diet 30 Acarbose 150-600 mg -0.9 -.4.5 -2.1
Glyburide (>15 mg/day) 49 Acarbose 150-600 mg -0.9 -4.1 -1.4
Metformin (1.5 g/day average) 35 Acarbose 150-600 mg -0.8 -3.5 -1.5
Insulin 35 Acarbose 150-600 mg -0.4 -2.7 +0.1
25 2 months (crossover) Gliclazide (240 mg) 18total Acarbose 300 mg Metformin 1.5 g -2.2-1.6 -5.3-2.9 -2.8-1.7
13 6 months Insulin 30 Placebo -0.9 NA NA
29 Acarbose 150-600 mg -1.6 NA NA
26 6 months Insulin 104 Placebo -0.17 +0.3 +0.7
103 Acarbose 150-900 mg -0.40 -2.8 -1.0

*Where the acarbose daily dose is designated as a range, treatment was initiated at the low dose and escalated to the maximum dose according to the protocol; fValues quoted for changes in glycemic parameters associated with drug treatments are ‘placebo-subtracted’ – for example, if the placebo group’s postprandial plasma glucose (PPG) fell 0.5 mmo/L and that of the acarbose group fell 1.5 mmol/L, then the net treatment effect will be quoted as-1.0. FPG Fasting plasma glucose; HbA1c Glycohemoglobin; NA Not available

TABLE 6 Efficacy of acarbose added to insulin therapy in insulin-dependent diabetes mellitus patients

Reference Study duration (± design) Total # patients Treatment and daily dose* Results (change from baseline)^HbAic (%) PPG (mmol/L) FPG (mmol/L)
27* 3 months (crossover) 137 Placebo 0 NA -0.67
Acarbose 150-300 mg -0.8 -2.11 -0.88
200++ 6 months 219 Placebo +0.06 +0.86 +0.65
Acarbose +0.04 -2.61 -0.02
6 months 236 Placebo +0.18 -0.64 -0.02
Acarbose -0.48 -2.50 -1.46

*Where the acarbose daily dose is designated as a range, treatment was initiated at the low dose and escalated to the maximum dose according to the protocol; fValues quoted for changes in glycemic parameters associated with drug treatments are ‘placebo-subtracted’ – for example, if the placebo group’s postprandial plasma glucose (PPG) fell 0.5 mmol/L and that of the acarbose group fell 1.5 mmol/L, then the net treatment effect will be quoted as -1.0; *Data as reported in the review by reference 4. FPG Fasting plasma glucose; HbA1c Glycohemoglobin; NA Not available


Acarbose monotherapy for NIDDM

Treatment with acarbose in NIDDM patients who are not adequately controlled on diet alone improves glycemic control. Placebo-controlled trials in which acarbose was used in diet-managed NIDDM patients are listed in Table 3. The daily dose of acarbose varied widely, ranging from 300 to 900 mg. The average ‘placebo-subtracted’ reduction (net treatment effect between the study and control groups) was about 3 mmol/L (range 2.1 to 4.6) for PPG, about 1.2 mmol/L (0 to 2.2) for FPG and about 1.1% (0.4 to 3.2) for HbA1c. The proportion of acarbose recipients who achieved a defined ‘positive response’ (reduction in HbA1c of at least 15%) in a 12-month trial was 52%, versus 26% of those receiving placebo. Maximal effects on PPG were seen by three months and no diminution of efficacy was observed throughout the study.

Category: Acarbose / Tags: Acarbose, Biguanides, Insulin, Metformin, Noninsulin-dependent diabetes mellitus, Sulphonylureas

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