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All Journal JURNAL FARMASI DAN ILMU KEFARMASIAN INDONESIA Denta: Jurnal Kedokteran Gigi
Libriansyah
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Chemistry Dentistry Education Health Professions Medicine & Pharmacology Other

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A Systematic Review: Cost-Effectiveness of SGLT2 Inhibitors versus DPP-4 Inhibitors as Add-on to Metformin Hanifiyah, Izzatu Al; Nita, Yunita; Libriansyah; Ridwan, Achmad
JURNAL FARMASI DAN ILMU KEFARMASIAN INDONESIA Vol. 12 No. 2 (2025): JURNAL FARMASI DAN ILMU KEFARMASIAN INDONESIA
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jfiki.v12i22025.256-263

Abstract

Background: The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP-4i) are two second-line therapy alternatives for T2DM patients inadequately controlled with metformin. Objective: This study aimed to systematically review the cost-effectiveness of combining metformin+SGLT2i vs metformin+DPP-4i for T2DM treatment. Methods: A systematic search was conducted in PubMed, Scopus, and ScienceDirect for articles published between 2015-2025, using predefined keywords and following the PRISMA and PICOS frameworks (P: T2DM patients uncontrolled on metformin monotherapy; I: Metformin+SGLT2i therapy; C: Metformin+DPP-4i therapy; O: Cost, clinical outcomes (HbA1c% reduction), Incremental Cost-Effectiveness Ratio (ICER) values, Quality Adjusted Life Years (QALY); S: Study with cost-effectiveness analysis design). Additional studies were identified through reference screening. Eligible articles were independently reviewed and assessed for reporting quality using the CHEERS-2022 standards. Results: Five studies met the inclusion criteria. Considerable heterogeneity was observed with mean patient ages ranging from 55-61 years old and baseline HbA1c levels from 7.9%-9.4%. The studies were conducted in the US, UK, Mexico, and Greece, all funded by the pharmaceutical industry, and used economic models. Despite these differences, all studies consistently demonstrated that combining metformin+SGLT2i was more cost-effective than metformin+DPP-4i. SGLT2i improved the quality of life by 0.032–0.04 QALYs, reduced hypoglycemia, and provided additional benefits for patients with cardiovascular risk, although it was associated with higher initial costs. Conclusion: This review showed that the combination of metformin+SGLT2i was more cost-efficient and effective in managing T2DM than the combination of metformin+DPP-4i.
Oral Health Care Management in Atypical Oral and Cutaneous Bullous Pemphigoid Widowati, Kharinna; Dewanthy P, Sri; Lukisari, Cane; Nafi’ah; Setianingtyas, Dwi; Rahman, Kurnia Hayati; Libriansyah; Riyanto, Eko; Damaiyanti, Dian W; Ayuningtyas, Nurina F.
Denta Journal Kedokteran Gigi Vol 20 No 1 (2026): Februari
Publisher : Fakultas Kedokteran Gigi Universitas Hang Tuah

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30649/denta.v20i1.4

Abstract

Background: Bullous Pemphigoid (BP) is the most common subepidermal bullous autoimmune disease, typically presenting as tense bullae. Atypical presentations of bullous pemphigoid often mimic TEN or impetigo, creating diagnostic ambiguity. Effective management of these cases requires integrated strategies to address systemic health factors and extensive oral mucosal involvement. Objective: This report highlights the Oral Health Care Management of atypical oral and cutaneous manifestations of Bullous Pemphigoid. Case: A 58-year-old woman with a history of Diabetes Mellitus and heart disease was referred with extensive bullae, erosions, and "honey-like" crusts involving over 30% of her body surface area. Her condition worsened despite two weeks of treatment with acyclovir, which was administered for suspected herpes. The presentation was highly suggestive of TEN and impetigo. Case Management: Management of the oral and perioral lesions focused on infection prevention and pain relief. Debridement was performed using sterile gauze soaked in normal saline and 0.2% chlorhexidine. This was followed by the application of Aloevera extract gel/spray. Comprehensive systemic therapy, including corticosteroids and immunosuppressants, was coordinated by a multidisciplinary team to control the autoimmune disease and its comorbidities. Conclusion: The presence of comorbidities, such as diabetes, further complicates systemic management and heightens the risk of secondary infections, requiring meticulous wound care. A multidisciplinary diagnostic algorithm, supported by supplementary examinations, is crucial for differentiating atypical BP from TEN and impetigo infection. Adequate management of associated oral and perioral manifestations is an integral component of comprehensive patient care.
Co-Authors Achmad Ridwan, Achmad Ayuningtyas, Nurina F. Cane Lukisari, Cane Dewanthy P, Sri Dian W Damaiyanti, Dian W Dwi Setianingtyas Hanifiyah, Izzatu Al Kharinna Widowati, Kharinna Nafi’ah Rahman, Kurnia Hayati Riyanto, Eko Yunita Nita