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Incretins – An attractive treatment option for type 2 diabetes1

Incretin-based therapies are available as1:

• IncretinmimeticsorGLP-1agonistssuchasByetta®(exenatide)

• IncretinenhancersorDPP-4inhibitorssuchasOnglyza®(saxagliptin)

Both incretin-based therapies achieve effective glycaemic control through a common GLP-1 pathway:

• Theirdifferences,however,needtobetakenintoconsiderationwhen selectinganincretin-basedtherapyforanindividualpatient1

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Incretin-based therapies: Major differences

GLP-1 agonist Byetta®

DPP-4 inhibitor Onglyza®

Properties/Effect

HbA1creduction -1.0%2 -0.7%3

Fastingandpostprandialglycaemiareduction4 +++ ++

Bodyweight4 Reduced Weightneutral

Gastricemptying1 Delayed Noeffect

Appetite1 Reduced Noeffect

Riskforhypoglycaemia4 Low Low

Adverseeffects4,5Gastrointestinal(mostlynausea)

Well-tolerated

Routeofadministration4 Twice-dailysubcutaneousinjection

Once-dailyoral

Key:+++ slightly more++ slightly less

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GLP-1 agonist Byetta®

DPP-4 inhibitor Onglyza®

Typical patient profile Typical patient profile • Patientwouldbenefitfromweight lossandreducedappetite4

• Patientwouldbenefitfromweight maintenance4

• Patientnotresistanttoinjectable therapy

• Patientprefersoraladministration

• Preferredatlaterstagesofdisease becauseofprogressivelossof GLP-1secretion4

• PreferredinearlyT2DMasadd-on tometformintoprovideglycaemic controlaftermetforminfailure4,6

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Patient Support Program Process Adding value to you and your patientsHowitworks:Callsmadebyhealthwindow

Call 2

Confirm patient completed

successfull face-to-face disease

education.

Re-inforceandexplainselfmonitoringandplottingofglucosereadingongraph

Discuss history of

disease and patient's knowledge on

disease.

Give patient info on his/her disease and

product.

Newsletter 1,2,3

regardingproductandDiseaseeducation:Diet/Exercise/Self-monitoring/General

Diabetesinformation/Onglyza®andByetta®Productinformation

Call 3 (Persistence)

Reinforcetheimportanceofcorrectandcontinueduseof

product.

Askpatientaboutselfmonitoringandplotting

ofglucosevalues

AskpatientsonFPG,PPGandHbA1C

readings.

Emotionalsupport

Givecallcentrecontactdetails

SMS 1+2

Remindpatienttoseedoctorfor

repeatscriptandselfmonitoring

Call 4 and 5

Reinforcetheimportanceofusingmedicationcorrectly.

Discuss importance of self monitoring.

Confirmifpatientdidgetrepeatscript.

Reaffirmtheavailabilityofcontinuoussupport(CallCentrecontact

number)

Refer uncontrolled patients back to Doctor

Month 2 Month 4 Month 5. 12 Month 7/8 and month 11Month 3. 6. 9

Increased compliance on Medication

Call 1

Welcomepatientontotheprogram

andexplaingoalandcarepathofprogram

Call Centre books clinic face-to-face

appointment

Enquire if patient has a blood glucose monitor and remind them to bring it to the face-to-face

appointment.

Ask baselineFPG,PPGandHbA1C

GivecontactdetailsofCallCentreand

website.

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PROVIDE SUPPORT AND ELIMINATE OBSTACLES TO TREATMENT

• Refer to clinic nurse for disease education. • Support journey to acceptance of living with diabetes • Educate patient on disease management • Support doctor’s treatment plan • Refer to multidisciplinary team if necessary (e.g. Doctor, Clinic nurse) • CLINIC: Nurse educates patient on disease and device (including diabetes, management, and self monitoring)

PATIENT SUPPORT PROGRAM • Initiate the patient on Onglyza® or Byetta® • Sign consent form with patient to be on PSP. • Consult patient when referred by Health Window during the patient support program. (12 month support program) • Continuation of treatment regimen

LIFESTYLE ADJUSTMENTS • Informed about the benefits and risks of adhering to treatment • Take ownership for lifestyle and treatment • Receives ongoing support and electronic newsletters

DOCTOR

PATIENT

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References

References:

1. Nisal K, Kela R, Khunti K, et al. Comparison of efficacy between incretin-based therapies for type 2 diabetes mellitus. BMC Medicine 2012;10:152. 2. Klonoff DC, Buse JB, Nielsen LL, et al. Exenatide effects on diabetes, obesity, cardiovascular risk factors and hepatic biomarkers in patients with type 2 diabetes treated for at least 3 years. Curr Med Res Opin 2008;24(1):275-286. 3. Defronzo RA, Duan RY, Hissa MN, et al. The efficacy and safety of saxagliptin when added to metformin therapy in patients with inadequately controlled type 2 diabetes with metformin alone. Diab Care 2009;32(9):1649-1655. 4. Cernea S. The role of incretin therapy at different stages of diabetes. Rev Diab Stud 2011;8(3):323-334. 5. Drucker DJ. The biology of incretin hormones. Cell Metabolism 2006;3:153-165. 6. Mazzola N. Review of current and emerging therapies in type 2 diabetes mellitus. Am J Man Care 2012;18:S17-S26.

S3 Onglyza® 2,5 (Tablet). Reg. No. 43/21.2/0608. Each tablet contains saxagliptin hydrochloride equivalent to 2,5 mg saxagliptin free base. S3 Onglyza® 5 (Tablet). Reg. No. 43/21.2/0609. Each tablet contains saxagliptin hydrochloride equivalent to 5 mg saxagliptin free base. PHARMACOLOGICAL CLASSIFICATION: A 21.2 Oral hypoglycaemics. INDICATIONS: ONGLYZA® is indicated as monotherapy as an adjunct to diet and exercise to improve glycaemic control in adult patients with type 2 diabetes mellitus. It is also indicated in combination therapy as add-on therapy in adult patients with type 2 diabetes mellitus to improve glycaemic control in combination with metformin, a thiazolidinedione, or a sulfonylurea, when the single agent alone, with diet and exercise, does not provide adequate glycaemic control. Safety has not been established in combination with insulin. For full prescribing information, kindly refer to the approved package insert. Onglyza® is a registered trademark of the AstraZeneca group of companies.

S3 BYETTA® 5 μg, solution for injection. Reg. No. 41/34/0068. Each dose contains 5 microgram (μg) exenatide in 20 microlitres (μl), (0,25 mg synthetic exenatide per ml). One pre-filled pen contains 60 doses of sterile, preserved solution (approximately 1,2 ml). S3 BYETTA® 10 μg, solution for injection. Reg. No. 41/34/0069. Each dose contains 10 microgram (μg) exenatide in 40 microlitres (μl), (0,25 mg synthetic exenatide per ml). One pre-filled pen contains 60 doses of sterile, preserved solution (approximately 2,4 ml). PHARMACOLOGICAL CLASSIFICATION: 32.16 Others. INDICATIONS: BYETTA® is indicated as add on therapy for patients with type 2 diabetes mellitus inadequately controlled by lifestyle modification and other oral antidiabetic therapy. For full prescribing information, kindly refer to the approved package insert. AstraZeneca Pharmaceuticals (Pty) Ltd. Reg. No. 1992/005854/07. Building 2, Northdowns Office Park, 17 Georgian Crescent West, Bryanston, 2191. Private Bag X23, Bryanston, 2021. Tel: 011 797-6000. Fax: 011 797-6001. www.astrazeneca.co.za. Byetta® is a registered trademark of the AstraZeneca group of companies. Expiry Date: February 2016. Activity ID: 127310

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