At the RPG Conference 2024, a poster presented by East and North Hertfordshire NHS Trust highlighted the results of an audit examining the RAG (Red, Amber, Green) ratings assigned to SGLT2 inhibitors—dapagliflozin and empagliflozin—and finerenone by ICBs in England.
These medications, endorsed by NICE guidelines for treating CKD, have demonstrated significant benefits in delaying CKD progression and reducing cardiovascular mortality. Despite this, the audit revealed considerable variation in how they are prescribed across England.
The study surveyed UK Renal Pharmacy Group members and reviewed ICB formularies to map the RAG ratings. Findings showed that dapagliflozin and empagliflozin were predominantly rated green (88% and 83%, respectively), allowing primary care initiation. In contrast, finerenone was more frequently rated amber (42%) or red (24%), indicating restrictions to secondary or tertiary care initiation.
The discussion underscored the need to explore barriers to consistent prescribing, such as training gaps or commissioning challenges. Extending the audit to devolved nations was proposed to better understand and address these disparities.
