This is a summary of the European public assessment report (EPAR) for Jalra. It explains how the Committee for Medicinal Products for Human Use (CHMP) assessed the medicine to reach its opinion in favour of granting a marketing authorisation and its recommendations on the conditions of use for Jalra.
What is Jalra?
Jalra is a medicine that contains the active substance vildagliptin. It is available as tablets (50 mg).
What is Jalra used for?
Jalra is used to treat type 2 diabetes mellitus. It can be used in the following ways:
•on its own (monotherapy) in patients whose diabetes is not sufficiently controlled by diet and exercise and who cannot take metformin;
•together with metformin, a thiazolidinedione or a sulphonylurea (dual therapy) when the patient’s diabetes is insufficiently controlled by this other medicine taken alone, but it is only used in combination with a sulphonylurea in patients who cannot take metformin;
•together with a sulphonylurea and metformin (triple therapy) in patients whose diabetes is not sufficiently controlled by these medicines plus diet and exercise;
•together with insulin (with or without metformin) in patients whose diabetes is not sufficiently controlled by diet and exercise plus a stable dose of insulin.
The medicine can only be obtained with a prescription.
How is Jalra used?
In adults, the recommended dose of Jalra is:
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•one tablet in the morning and another in the evening (100 mg per day), when used alone, with metformin, with a thiazolidinedione, with metformin plus a sulphonylurea, or with insulin (with or without metformin);
•one tablet in the morning (50 mg per day) when taken with a sulphonylurea. A lower dose of the sulphonylurea may also be considered to reduce the risk of hypoglycaemia (low blood glucose levels).
The daily dose should not exceed two tablets (100 mg).
Jalra is not recommended for patients who have moderate or severe problems with their kidneys, including those on haemodialysis (a blood clearance technique) with
How does Jalra work?
Type 2 diabetes is a disease in which the pancreas does not make enough insulin to control the level of glucose (sugar) in the blood or when the body is unable to use insulin effectively. The active substance in Jalra, vildagliptin, is a dipeptidyl peptidase 4
How has Jalra been studied?
Jalra has been studied in eleven main studies involving a total of over 5,000 patients with type 2 diabetes and insufficient control of blood glucose levels.
Five of these studies looked at the effects of Jalra taken alone in a total of 3,644 patients, comparing it with placebo (a dummy treatment), metformin, rosiglitazone (a thiazolidinedione) or or gliclazide (a sulphonylurea).
Four studies compared the effects of Jalra, taken at doses of 50 or 100 mg a day for 24 weeks, with those of placebo, when used as an
A further study compared Jalra with placebo as an
A further study compared Jalra with placebo as an
In all studies, the main measure of effectiveness was the change in blood levels of a substance called glycosylated haemoglobin (HbA1c), which gives an indication of how well blood glucose is controlled.
What benefit has Jalra shown during the studies?
Jalra used on its own was effective at reducing levels of HbA1c, but was less effective than the comparator medicines. In the study comparing Jalra with metformin, significantly better results were
seen with metformin: a reduction in HbA1c of 1.5 percentage points after 52 weeks compared with a reduction of around 1 percentage point in patients treated with Jalra.
When used as an
In combination with metformin and glimepiride, 50 mg Jalra taken twice a day reduced HbA1c levels by 1 percentage point, compared with a reduction of 0.3 percentage points in patients taking placebo.
In the study involving 296 patients taking insulin, adding Jalra caused a greater reduction in HbA1c levels than adding placebo, but the size of this effect was small possibly due to the fact that the study included
What is the risk associated with Jalra?
The most common side effect with Jalra (seen in between 1 and 10 patients in 100) is dizziness. For the full list of all side effects reported with Jalra, including side effects occurring when Jalra is taken with other antidiabetes medicines, see the package leaflet.
Jalra must not be used in people who are hypersensitive (allergic) to vildagliptin or any of the other ingredients. Its use in patients with heart disease should be limited to patients with mild disease.
Because vildagliptin has been associated with liver problems, patients should have tests to check their liver function before treatment with Jalra and at regular intervals during treatment.
Why has Jalra been approved?
The CHMP noted that Jalra was effective as an
The CHMP also considered the use of Jalra on its own and concluded that it was effective in reducing blood glucose but was less effective than metformin. Jalra should therefore be used only in patients for whom metformin is inappropriate either because of side effects occurring with metformin or because they have a condition that makes metformin unsuitable for them.
Other information about Jalra
The European Commission granted a marketing authorisation valid throughout the European Union for Jalra on 19 November 2008.
The full EPAR for Jalra can be found on the Agency’s website ema.europa.eu/Find medicine/Human medicines/European Public Assessment Reports. For more information about treatment with Jalra, read the package leaflet (also part of the EPAR) or contact your doctor or pharmacist.
This summary was last updated in