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생명환경공학과 20072170 한은정 유기화학 과제
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진료지침 5판 2부_당뇨병의 관리
대한당뇨병학회 진료지침위원회 안유배 위원장
- “병용약물 급여확대 허가사항과 불일치”
- DPP-4 억제제는 ‘메트포르민+설포닐우레아’에 추가 때만 인정
이번 진료지침은 지난 1일 당뇨병 약물의 병용요법과 삼제요법에 대한 급여인정 고시와 시기가 맞물리면서 임상현장에서의 적용 역시 탄력을 받을 것으로 전망되고 있다. 보험급여에서 추가적으로 인정된 부분은 병용요법·삼제요법이다. 기존 메트포르민이나 설포닐우레아 외 병용요법에서 투약비용이 저렴한 약물에 대한 비용을 환자가 부담하도록 한 것에서 병용약물 모두의 급여를 인정한 것으로, 메글리티나이드+알파-글루코시다아제, 메글리니타이드+티아졸리딘디온, 티아졸리딘디온+DPP-4 억제제 전략도 급여를 인정받게 됐다.
또 삼제요법에서도 2제 병용요법을 2~4개월 이상 투여해도 A1C가 7% 이상으로 나타날 경우, 병용요법에서 인정되는 범위에서 다른 기전의 당뇨병 약물 한 개를 추가로 투여하는 부분까지 인정하고 있다.
하지만 진료지침에서 제시하고 있는 약물치료 전략의 발목을 잡고 있는 부분은 식약처 허가사항이다. 안유배 학회 진료지침위원장(가톨릭의대 내분비내과)은 "현재 메트포르민+티아졸리딘디온에 DPP-4 억제제를 추가하는 전략에서 식약처 허가사항과 보건복지부 급여기준이 일치하지 않는 부분이 있다"며, "DPP-4 억제제에 대한 식약처 허가사항에서는 삼제요법을 메트포르민+설포닐우레아에 추가할 경우만 명시하고 있다"고 설명했다.
그나마 이 논란에 해당되는 약물도 시타글립틴과 빌다글립틴뿐이다. 보건복지부가 급여기준을 검토할 때 두 약물 외 다른 DPP-4 억제제는 식약처 승인도 받지 못한 상황이었기 때문에 해당사항이 없다는 것이다.
현재 학회는 부처 관계자들과 조율을 진행하고 있어, 추후 이에 대한 합의가 어떻게 이뤄질지에도 관심이 집중되고 있다.
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Similar to Ripitor(1)
Lotrel
Lotrel is indicated for the treatment of hypertension.
This fixed combination drug is not indicated for the initial therapy of
hypertension (see DOSAGE AND ADMINISTRATION).
In using Lotrel, consideration should be given to the fact that an ACE inhibitor,
captopril, has caused agranulocytosis, particularly in patients with renal impairment or
collagen-vascular disease. Available data are insufficient to show that benazepril does not
have a similar risk
진료지침 5판 2부_당뇨병의 관리
대한당뇨병학회 진료지침위원회 안유배 위원장
- “병용약물 급여확대 허가사항과 불일치”
- DPP-4 억제제는 ‘메트포르민+설포닐우레아’에 추가 때만 인정
이번 진료지침은 지난 1일 당뇨병 약물의 병용요법과 삼제요법에 대한 급여인정 고시와 시기가 맞물리면서 임상현장에서의 적용 역시 탄력을 받을 것으로 전망되고 있다. 보험급여에서 추가적으로 인정된 부분은 병용요법·삼제요법이다. 기존 메트포르민이나 설포닐우레아 외 병용요법에서 투약비용이 저렴한 약물에 대한 비용을 환자가 부담하도록 한 것에서 병용약물 모두의 급여를 인정한 것으로, 메글리티나이드+알파-글루코시다아제, 메글리니타이드+티아졸리딘디온, 티아졸리딘디온+DPP-4 억제제 전략도 급여를 인정받게 됐다.
또 삼제요법에서도 2제 병용요법을 2~4개월 이상 투여해도 A1C가 7% 이상으로 나타날 경우, 병용요법에서 인정되는 범위에서 다른 기전의 당뇨병 약물 한 개를 추가로 투여하는 부분까지 인정하고 있다.
하지만 진료지침에서 제시하고 있는 약물치료 전략의 발목을 잡고 있는 부분은 식약처 허가사항이다. 안유배 학회 진료지침위원장(가톨릭의대 내분비내과)은 "현재 메트포르민+티아졸리딘디온에 DPP-4 억제제를 추가하는 전략에서 식약처 허가사항과 보건복지부 급여기준이 일치하지 않는 부분이 있다"며, "DPP-4 억제제에 대한 식약처 허가사항에서는 삼제요법을 메트포르민+설포닐우레아에 추가할 경우만 명시하고 있다"고 설명했다.
그나마 이 논란에 해당되는 약물도 시타글립틴과 빌다글립틴뿐이다. 보건복지부가 급여기준을 검토할 때 두 약물 외 다른 DPP-4 억제제는 식약처 승인도 받지 못한 상황이었기 때문에 해당사항이 없다는 것이다.
현재 학회는 부처 관계자들과 조율을 진행하고 있어, 추후 이에 대한 합의가 어떻게 이뤄질지에도 관심이 집중되고 있다.
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Ripitor(1)
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