Therapeutic Area: Diabetes Mellitus, Type 2
Pharmacotherapeutic Group: Drugs used in diabetes
Competact is indicated in the treatment of type 2 diabetes mellitus patients, particularly overweight patients, who are unable to achieve sufficient glycaemic control at their maximally tolerated dose of oral metformin alone.
What is Competact?
Competact is a medicine that is available as white oblong tablets containing two active substances, pioglitazone (15 mg) and metformin hydrochloride (850 mg).
What is Competact used for?
Competact is used in adults (particularly those who are overweight) who have type 2 diabetes. Competact is used in patients who are not satisfactorily controlled on metformin (an anti-diabetes medicine) used on its own and at the maximum possible dose.
Competact can only be obtained with a prescription.
How is Competact used?
The usual dose of Competact is one tablet taken twice a day. Patients changing from metformin only to Competact may need to slowly introduce pioglitazone until a dose of 30 mg per day is reached. It is possible to change to Competact directly from metformin if appropriate. Taking Competact with or just after food may reduce any stomach problems caused by metformin. Elderly patients should have their kidney function monitored regularly.
How does Competact work?
Type 2 diabetes is a disease in which the pancreas does not make enough insulin to control the level of glucose in the blood or when the body is unable to use insulin effectively. Competact contains two active substances which each have a different mode of action. Pioglitazone makes cells (fat, muscle and liver) more sensitive to insulin, which means that the body makes better use of the insulin it produces. Metformin works mainly by inhibiting glucose production and reducing its absorption in the gut. As a result of the action of both active substances, the blood glucose is reduced and this helps to control type 2 diabetes.
How has Competact been studied?
Pioglitazone on its own has been approved by the EU under the name Actos, can be used with metformin in type 2 diabetes patients who are not satisfactorily controlled on metformin alone. Three studies of Actos used with metformin as separate tablets were used to support the use of Competact in the same indication. The studies lasted from 4 months to 2 years and involved 1,305 patients who took the combination. They measured the level in the blood of a substance (HbA1c), which gives an indication of how well the blood glucose is controlled.
Treatment with Competact should be reviewed after three to six months, and discontinued in patients who are not deriving sufficient benefit. At subsequent reviews prescribers should confirm that benefits to patients are maintained.
What benefit has Competact shown during the studies?
In all studies, adding pioglitazone 30 mg to metformin gave an improvement in the control of blood glucose, with levels of HbA1c which were further decreased by 0.64 to 0.89% compared to the levels on metformin alone.
What is the risk associated with Competact?
At the start of treatment, abdominal pain (stomach ache), diarrhoea, loss of appetite, nausea (feeling sick) and vomiting may occur. These side effects are very common but disappear on their own in most cases. Lactic acidosis (a build-up of lactic acid in the body) is a side effect which may occur in less than 1 in 10,000 patients. Other side effects such as bone fracture, increased weight and oedema (swelling) may occur in less than 1 in 10 patients. For the full list of side effects reported with Competact, see the package leaflet.
Competact should not be used in people who may be hypersensitive (allergic) to pioglitazone, metformin or any of the other ingredients, and in patients who have heart failure, or problems with their liver or their kidneys. Competact should not be used in patients who have a disease that causes lack of oxygen to the tissues such as a recent heart attack or shock. Competact should not be used where there is alcohol intoxication, diabetic ketoacidosis (high levels of ketones), conditions that may effects the kidneys, and during breast-feeding. It must also not be used in patients who have or have had bladder cancer or those with blood in the urine that has not yet been investigated. For the full list of restrictions, see the package leaflet.
Why has Competact been approved?
The CHMP concluded that the effectiveness of pioglitazone and metformin in type diabetes 2 had been shown, and that Competact simplifies treatment and improves compliance when a combination of the active substances is required. The Committee decided that Competact’s benefits are greater than its risks and recommended that it be given marketing authorisation.
For more information about treatment with Competact, read the package leaflet (also part of the EPAR) or contact your doctor or pharmacist.