瑞格列奈与那格列奈的Mini卫生技术评估

Mini Health Technology Assessment of Repaglinide and Naglinide

目的:为医院决策者遴选、临床合理使用瑞格列奈与那格列奈提供依据。方法:通过文献、指南、说明书查阅,药师与医师沟通建立百分制评分体系,从临床必要性、有效性、安全性、经济性、医保属性、基本药物属性、原研属性、药品包装属性、市场属性及企业属性等方面分别对瑞格列奈与那格列奈进行Mini卫生技术评估(Mini HTA),并结合权重值对其进行评分。结果:瑞格列奈与那格列奈最终分值分别为77分和74分;二者用于治疗2型糖尿病均可有效降低患者的餐后血糖,且副作用小、安全性佳;均为医保目录收录品种,均是原研药品,且便于贮藏,有效期均较长;尽管二者的价格偏高但其生产企业信誉度良好、且在全球范围内广泛使用,是2型糖尿病患者的优良选择。但二者也有一定差异,瑞格列奈可应用于肾功能较差[肾小管滤过率预估值(e GFR)<30 mL/min]的患者且不需调整剂量,那格列奈因经肾脏排泄故需根据eGFR调整剂量;瑞格列奈属于基本药物而那格列奈为非基本药物;瑞格列奈不需遮光贮藏而那格列奈需注意遮光贮藏。此外,多种肝药酶诱导剂或抑制剂均可与二者产生相互作用,特殊人群应谨慎用药。结论:本次Mini HTA可为医院遴选及合理使用瑞格列奈与那格列奈提供参考依据。2型糖尿病患者可结合自身条件及需求合理选择使用两种药品;与其他药物合用时需密切监测血糖,防止低血糖的发生。

OBJECTIVE:To provide reference for hospital decision-maker to select and use repaglinide and naglinide reasonably.METHODS:Through reviewing literautre,guideline and instruction,full score system was estalished for comunnication between pharmacists and physicians;from the aspects of clinical necessity,effectiveness,safety,economy,medical insurance attribute,essential medicine attribute,original research attribute,drug packaging attribute,drug market and enterprise attributes,the Mini health technology assessment(Mini HTA)was carried out for repaglinide and nateglinide,and scored on the basis of weight value.RESULTS:Repaglinide and naglinide’s final score were 77 and 74,respectively.For type 2 diabetes,both of them could reduce postprandial blood glucose,and had less side effect and good safety.They were both included in the medical insurance list.Both of them were original varieties,easy to store and had a long period of validity.Although they were expensive in the treatment of type 2 diabetes,their manufacturers had a good reputation and were widely used in the world,which was a good choice for patients with type 2 diabetes.But they were different to certain extent;repaglinide could be used in patients with poor renal function[eGFR<30 m L/min]without dose adjustment;nateglinide should be adjusted according to e GFR for renal excretion.Repaglinide was essential medicine but nateglinide wasn’t;repaglinide didn’t need shading storage but nateglinide did.In addition,a variety of liver drug enzyme inducers or inhibitors may interact with the two drugs,and special groups should be used withcaution.CONCLUSIONS:Mini HTA provide reference for the selection and rational use of repaglinide and nateglinide;patients with type 2 diabetes can select suitable drug according to their own conditions and needs.When combined with other drugs,blood glucose should be closely monitored to prevent the occurrence of hypoglycemia.