Key data evaluating the efficacy and safety
of dapagliflozin in combination with other type 2 diabetes
therapies head-to-head vs. insulin or sulfonylurea
Latest data from the DEPICT clinical program
evaluating dapagliflozin to address an unmet need for oral therapy
in adult patients with type 1 diabetes
Debut of pre-clinical and clinical data for
MEDI0382 in type 2 diabetes, a potential first-in-class
oxyntomodulin-like peptide
AstraZeneca and its global biologics research and development
arm, MedImmune, will present 45 abstracts including seven
late-breaking data disclosures from the Company’s Cardiovascular
(CV), Renal and Metabolism (CVRM) therapy area at the American
Diabetes Association’s (ADA) 78th Scientific Sessions in Orlando,
Florida, June 22-26, 2018.
This latest research will help to inform clinical practice with
FARXIGA® (dapagliflozin) and BYDUREON® (exenatide extended-release)
in type 2 diabetes (T2D), including data on their use alone and in
combination with other diabetes therapies. Highlights also include
data on the potential new use of dapagliflozin in type 1 diabetes
(T1D) and the debut of pre-clinical and clinical data for MEDI0382,
an oxyntomodulin-like peptide and potential new medicine. MEDI0382
has the potential to be a first- in- class therapy and is the
latest candidate to advance in the Company’s CVRM pipeline.
Commenting on AstraZeneca’s scientific approach in CVRM, Ludovic
Helfgott, Vice President, Cardiovascular, Renal and Metabolism,
said: “At ADA this year, we are sharing data on novel approaches
and potential new medicines as we continue to advance treatments
for patients with diabetes. At AstraZeneca, we recognize the
critical interconnectivity between cardiovascular, renal and
metabolic diseases, and aim to deliver leading science that
addresses patient needs across the global burden of these
conditions.”
Clinical and real-world evidence data further evaluating
dapagliflozin in T2D
Highlights include several abstracts evaluating the effects of
dapagliflozin on glycemic control and additional endpoints,
including blood pressure and body weight, alone and in combination
with other diabetes treatments across a broad range of patients.
Dapagliflozin is not indicated for weight loss or for the treatment
of hypertension.
Presentations assessing the combination of dapagliflozin and
saxagliptin, include 24-week results of dapagliflozin as add- on
therapy to saxagliptin, in addition to metformin compared with
insulin in patients with or without sulfonylurea therapy.
AstraZeneca will also present long-term data from the DURATION-8
trial over 104 weeks (Late-breaking Poster 104-LB), which
evaluated the efficacy and safety of dapagliflozin once daily in
combination with weekly exenatide extended-release vs. each
treatment alone.
New analyses from the EXSCEL (Exenatide Study of Cardiovascular
Event Lowering) CV outcomes trial will be presented in a late
breaking poster which will evaluate the CV and renal effects in
patients that received SGLT-2 inhibitor (SGLT-2i) in the placebo
group, and a moderated poster will provide insights on the renal
outcomes observed with exenatide extended-release. Exenatide
extended-release and dapagliflozin are not indicated to reduce the
risk of cardiovascular or renal outcomes.
A new analysis of the landmark CVD-REAL study presented as a
late-breaking poster, comparing the risk of all-cause mortality,
hospitalization for heart failure (hHF), myocardial infarction and
stroke in patients with T2D starting treatment with dapagliflozin
vs. any DPP-4 inhibitor, based on data from Canada, Israel, Japan
and South Korea. CVD-REAL provides real-world evidence of
dapagliflozin on these CV outcomes, while DECLARE (Dapagliflozin
Effect on CardiovascuLAR Events) will evaluate the CV efficacy and
safety of dapagliflozin in the largest SGLT-2i CV outcomes trial in
a broad range of patients with T2D, including those with multiple
CV risk factors or established CV disease. The trial is
anticipated to read out in the second half of 2018. Dapagliflozin
is not indicated to reduce the risk of death, hospitalization for
heart failure, or CV outcomes.
Data evaluating the potential of dapagliflozin to address an
unmet need in patients with T1D
Currently, there are no oral treatment options approved for
adult patients with T1D. The latest data from the DEPICT
(Dapagliflozin Evaluation in Patients with Inadequately Controlled
Type 1 Diabetes) clinical program will include results on the
efficacy and safety of dapagliflozin as add on to insulin over 52
weeks (from DEPICT-1) and 24 weeks (from DEPICT-2), as well as a
pooled analyses of continuous glucose monitoring (CGM) data from
both trials. Dapagliflozin is not approved for T1D.
First pre-clinical and clinical data for MEDI0382 in
T2D
From the Company’s promising CVRM pipeline, MedImmune will
present primary results from its MEDI0382 Phase 2a trial. MEDI0382
is an oxyntomodulin-like peptide and potential new medicine
designed to simultaneously activate the glucagon-like peptide 1
(GLP-1) and glucagon (GLU) receptors, with the goals of achieving
glucose control, reduced body weight and increased energy
expenditure in patients with T2D. Oxyntomodulin is a peptide
hormone released from the gut that targets the GLP-1 and glucagon
receptors, both of which are critical to controlling metabolic
functions. In addition, two oral presentations will feature data on
the effects of MEDI0382 on hepatic (liver) fat in patients with
T2D, and its effects on pancreatic and incretin hormones,
respectively.
Details of the key abstracts from AstraZeneca/MedImmune are as
follows:
Abstract title
Presentation details Short-term and long-term data for
dapagliflozin in combination with other T2D therapies Effect of
Dapagliflozin Plus Saxagliptin vs. Insulin Glargine on A1C in
patients With Type-2 Diabetes Inadequately Controlled by Metformin
with or without Sulfonylurea Oral 260-OR, Monday,
June 25, 09:30 - 09:45 EDT Dapagliflozin Plus Saxagliptin Add-On
vs. Glimepiride Add-On to Metformin in Patients with Poorly
Controlled Type-2 Diabetes Oral 261-OR, Monday, June
25, 09:45 - 10:00 EDT Durability of Glycemic Control with
Dapagliflozin vs Saxagliptin in Patients with Inadequately
Controlled Type-2 Diabetes Poster 1181-P, Sunday,
June 24, 12:00 - 13:00 EDT Triple vs. Dual Therapy with Low-Dose
Dapagliflozin Plus Saxagliptin vs. Each Monocomponent Added to
Metformin in Uncontrolled Type-2 Diabetes Poster
1149-P, Sunday, June 24, 12:00 - 13:00 EDT DURATION-8 Randomized
Controlled Trial 104-Week Results: Once-Weekly Exenatide (ExQW)
Plus Once-Daily Dapagliflozin (DAPA) Versus ExQW or DAPA Alone
Late-breaking Poster 104-LB, Monday, June 25, 12:00 -
13:00 EDT
Analyses of renal and SGLT-2i outcomes in the
EXSCEL trial Impact of SGLT2 Inhibitors (SGLT2i) on
Cardiovascular (CV) Risk and Estimated Glomerular Filtration Rate
(eGFR) in the EXSCEL Placebo Group Late-breaking
Poster 130-LB, Monday, June 25, 12:00 - 13:00 EDT Renal Outcomes in
the EXenatide Study of Cardiovascular Event Lowering (EXSCEL)
Poster 522-P, General Session, Saturday, June 23,
11:30 - 12:30 EDT and Moderated Poster Session, Monday, June 25,
12:00 - 13:00 EDT
Real-world evidence evaluating CV
outcomes with SGLT2i vs. DPP-4 Analysis of Risk of CV Events
and Death Associated with Initiation of SGLT-2 vs. DPP-4 Inhibitors
from the CVD-REAL 2 Study Late-breaking Poster
124-LB, Monday, June 25, 12:00 - 13:00 EDT
Short-term and
long-term data for dapagliflozin in T1D Efficacy and Safety of
Dapagliflozin in Patients with Inadequately Controlled Type-1
Diabetes: DEPICT-2 Study Oral 213-OR, Sunday, June
24, 16:00 EDT Long-Term Efficacy and Safety of Dapagliflozin in
Patients with Inadequately Controlled Type-1 Diabetes: The DEPICT-1
Study Late-breaking Poster 119-LB, Monday, June 25,
12:00 - 13:00 EDT Glucose Variables in T1D Studies with
Dapagliflozin: Pooled Analysis of Continuous Glucose Monitoring
Data from DEPICT-1 and 2 Late-breaking Poster 125-LB,
Monday, June 25, 12:00 - 13:00 EDT
Clinical and
pre-clinical data for MEDI0382, a novel oxyntomodulin-like (OXM)
peptide Effect of MEDI0382 on Hepatic Fat Content in Subjects
with Type-2 Diabetes Mellitus Oral 78-OR, Saturday,
June 23, 08:00 - 10:00 EDT Effects of MEDI0382 on Insulin, Glucagon
and Incretin Hormone Profiles Oral 79-OR, Saturday,
June 23, 08:00 - 10:00 EDT Evaluation of Glucose Control and Weight
Loss with MEDI0382, a GLP-1/Glucagon Receptor Dual Agonist, in a
6-week Phase 2A Study of T2DM Subjects Poster 1067-P,
Sunday, June 24, 12:00 PM - 13:00 EDT
Latest analyses of
the leading global diabetes registries Vascular Events in
Patients with Type-2 Diabetes in the Year Following Initiation of
Second-line Therapy: the DISCOVER Study Poster
1562-P, Sunday, June 24, 12:00-13:00 EDT Composite Cardiovascular
Risk Factor Target Achievement and its Indicators in US Adults with
Diabetes: The Diabetes Collaborative Registry Poster
1487-P, Sunday, June 24, 12:00 - 13:00 EDT
CV outcomes
and mortality in T2D with associated CV, renal and metabolic
co-morbidities Cardiovascular Outcomes and Mortality in Type-2
Diabetes with Associated Cardio-Renal-Metabolic Co-Morbidities
Poster 1582-P, Sunday, June 24, 12:00 - 13:00 EDT
The full list of AstraZeneca/MedImmune scientific data can be
accessed on the ADA website here. You can also follow us live
during ADA 2018 on Twitter.
INDICATION AND LIMITATIONS OF USE FOR FARXIGA
(dapagliflozin) tablets 5 mg and 10 mg
FARXIGA is indicated as an adjunct to diet and exercise to
improve glycemic control in adults with type 2 diabetes
mellitus.
FARXIGA is not recommended for patients with type 1 diabetes
mellitus or for the treatment of diabetic ketoacidosis.
Please read US Full Prescribing
Information and Medication
Guide for FARXIGA.
IMPORTANT SAFETY INFORMATION FOR FARXIGA
Contraindications
- Prior serious hypersensitivity reaction
to FARXIGA
- Severe renal impairment (eGFR <30
mL/min/1.73 m2), end-stage renal disease, or patients on
dialysis
Warnings and Precautions
- Hypotension: FARXIGA causes
intravascular volume contraction, and symptomatic hypotension can
occur. Assess and correct volume status before initiating FARXIGA
in patients with impaired renal function, elderly patients, or
patients on loop diuretics. Monitor for hypotension
- Ketoacidosis has been
reported in patients with type 1 and type 2 diabetes receiving
FARXIGA. Some cases were fatal. Assess patients who present with
signs and symptoms of metabolic acidosis for ketoacidosis,
regardless of blood glucose level. If suspected, discontinue
FARXIGA, evaluate and treat promptly. Before initiating FARXIGA,
consider risk factors for ketoacidosis. Patients on FARXIGA may
require monitoring and temporary discontinuation in situations
known to predispose to ketoacidosis
- Acute Kidney Injury and Impairment
in Renal Function: FARXIGA causes intravascular volume
contraction and renal impairment, with reports of acute kidney
injury requiring hospitalization and dialysis. Consider temporarily
discontinuing in settings of reduced oral intake or fluid losses.
If acute kidney injury occurs, discontinue and promptly
treat.FARXIGA increases serum creatinine and decreases eGFR.
Elderly patients and patients with impaired renal function may be
more susceptible to these changes. Before initiating FARXIGA,
evaluate renal function and monitor periodically. FARXIGA is not
recommended in patients with an eGFR persistently between 30
and <60 mL/min/1.73 m2
- Urosepsis and
Pyelonephritis: SGLT2 inhibitors increase the risk for
urinary tract infections [UTIs] and serious UTIs have been reported
with FARXIGA. Evaluate for signs and symptoms of UTIs and treat
promptly
- Hypoglycemia: FARXIGA can
increase the risk of hypoglycemia when coadministered with insulin
and insulin secretagogues. Consider lowering the dose of these
agents when coadministered with FARXIGA
- Genital Mycotic
Infections: FARXIGA increases the risk of genital mycotic
infections, particularly in patients with prior genital mycotic
infections. Monitor and treat appropriately
- Increases in Low-Density Lipoprotein
Cholesterol (LDL-C) occur with FARXIGA. Monitor LDL-C and
treat per standard of care
- Bladder cancer: An
imbalance in bladder cancers was observed in clinical trials. There
were too few cases to determine whether the emergence of these
events is related to FARXIGA, and insufficient data to determine
whether FARXIGA has an effect on pre-existing bladder tumors.
FARXIGA should not be used in patients with active bladder cancer.
Use with caution in patients with a history of bladder cancer
- Macrovascular
Outcomes: There have been no clinical studies establishing
conclusive evidence of macrovascular risk reduction with
FARXIGA
Adverse Reactions
In a pool of 12 placebo-controlled studies, the most common
adverse reactions (≥5%) associated with FARXIGA 5 mg, 10 mg, and
placebo respectively were female genital mycotic infections (8.4%
vs 6.9% vs 1.5%), nasopharyngitis (6.6% vs 6.3% vs 6.2%), and
urinary tract infections (5.7% vs 4.3% vs 3.7%).
Use in Specific Populations
- Pregnancy: Advise females
of potential risk to a fetus especially during the second and third
trimesters.
- Lactation: FARXIGA is not
recommended when breastfeeding
INDICATION AND LIMITATIONS OF USE FOR BYDUREON®
(exenatide extended-release) for injectable suspension
2mg
BYDUREON and BYDUREON BCise are both indicated as an adjunct to
diet and exercise to improve glycemic control in adults with type 2
diabetes mellitus
- Not recommended as first-line therapy
for patients inadequately controlled on diet and exercise
- Not a substitute for insulin. Should
not be used to treat type 1 diabetes or diabetic ketoacidosis
- Not recommended for use with
insulin
- Do not coadminister with other
exenatide-containing products
- Not studied in patients with a history
of pancreatitis. Consider other antidiabetic therapies in patients
with a history of pancreatitis
IMPORTANT SAFETY INFORMATION ABOUT BYDUREON AND BYDUREON
BCISE, INCLUDING BOXED WARNING
WARNING: RISK OF THYROID C-CELL TUMORS
- Exenatide extended-release causes an
increased incidence in thyroid C-cell tumors at clinically relevant
exposures in rats compared to controls. It is unknown whether
BYDUREON or BYDUREON BCise cause thyroid C-cell tumors, including
medullary thyroid carcinoma (MTC), in humans, as the human
relevance of exenatide extended-release-induced rodent thyroid
C-cell tumors has not been determined
- BYDUREON and BYDUREON BCise are
contraindicated in patients with a personal or family history of
MTC or in patients with Multiple Endocrine Neoplasia syndrome type
2 (MEN 2). Counsel patients regarding the potential risk of MTC
with the use of BYDUREON or BYDUREON BCise and inform them of
symptoms of thyroid tumors (eg, mass in the neck, dysphagia,
dyspnea, persistent hoarseness). Routine monitoring of serum
calcitonin or using thyroid ultrasound is of uncertain value for
detection of MTC in patients treated with BYDUREON or BYDUREON
BCise
CONTRAINDICATIONS
- Personal or family history of MTC,
patients with MEN 2
- Prior serious hypersensitivity
reactions to exenatide or product components
WARNINGS AND PRECAUTIONS
- Acute
Pancreatitis including fatal and non-fatal hemorrhagic or
necrotizing pancreatitis has been reported. After initiation,
observe patients carefully for symptoms of pancreatitis. If
suspected, discontinue promptly and do not restart if confirmed.
Consider other antidiabetic therapies in patients with a history of
pancreatitis
- Hypoglycemia Risk of
hypoglycemia is increased when exenatide is coadministered with
insulin or insulin secretagogues. Consider lowering the dose of
these agents when coadministered with BYDUREON or BYDUREON
BCise
- Acute Kidney Injury and Impairment
of Renal Function Altered renal function, including
increased serum creatinine, renal impairment, worsened chronic
renal failure, and acute renal failure, sometimes requiring
hemodialysis and kidney transplantation have been reported. Not
recommended in patients with severe renal impairment or end-stage
renal disease. Use caution in patients with renal transplantation
or moderate renal impairment
- Gastrointestinal
Disease Because exenatide is commonly associated with
gastrointestinal adverse reactions, not recommended in patients
with severe gastrointestinal disease (eg, gastroparesis)
- Immunogenicity Patients may
develop antibodies to exenatide. Patients with higher titer
antibodies may have an attenuated HbA1c response. In clinical
trials, attenuated glycemic response was associated with BYDUREON-
or BYDUREON BCise-treated patients. If worsening of or failure to
achieve adequate glycemic control occurs, consider alternative
antidiabetic therapy
- Hypersensitivity Reports of
serious hypersensitivity reactions (eg, anaphylaxis and
angioedema). If this occurs, patients should discontinue BYDUREON
or BYDUREON BCise and promptly seek medical advice
- Injection-Site
Reactions Serious reactions (eg, abscess, cellulitis, and
necrosis), with or without subcutaneous nodules, have been
reported
- Macrovascular Outcomes No
clinical studies establishing conclusive evidence of macrovascular
risk reduction with exenatide
ADVERSE REACTIONS
- Most common (≥5%) and occurring more
frequently than comparator in BYDUREON clinical trials: nausea
(16.9%), diarrhea (12.7%), headache (8.0%), vomiting (6.8%),
constipation (5.9%), injection-site pruritus (5.9%), injection-site
nodule (5.3%), dyspepsia (5.1%)
- Most common (≥5%) in BYDUREON BCise
clinical trials: injection-site nodule (10.5%), nausea (8.2%)
DRUG INTERACTIONS
- Oral Medications BYDUREON
and BYDUREON BCise slow gastric emptying and may reduce the rate of
absorption of orally administered drugs
- Warfarin Increased
international normalized ratio (INR) sometimes associated with
bleeding has been reported with concomitant use of exenatide with
warfarin. Monitor INR frequently until stable upon initiation of
BYDUREON or BYDUREON BCise
PREGNANCY
Use during pregnancy only if the potential benefit justifies the
potential risk to the fetus.
Please click here for Prescribing
Information and Medication Guide for BYDUREON BCise.
Please click here for Prescribing
Information and Medication Guide for BYDUREON.
INDICATIONS AND LIMITATIONS OF USE FOR ONGLYZA®
(saxagliptin) tablets 5mg
ONGLYZA is indicated as an adjunct to diet and exercise to
improve glycemic control in adults with type 2 diabetes
mellitus.
ONGLYZA is not indicated for the treatment of type 1 diabetes
mellitus or diabetic ketoacidosis.
Important Safety Information for ONGLYZA
Contraindications
Prior serious hypersensitivity reaction to ONGLYZA
Pancreatitis: There have been postmarketing reports of
acute pancreatitis in patients taking ONGLYZA, and in the SAVOR
cardiovascular outcomes trial. Observe for pancreatitis. If
pancreatitis is suspected, discontinue ONGLYZA.
Heart Failure: In the SAVOR cardiovascular outcomes
trial, more patients treated with ONGLYZA were hospitalized for
heart failure compared to placebo. Patients with a prior history of
heart failure or renal impairment had a higher risk for
hospitalization for heart failure. Consider the risks and benefits
of ONGLYZA in patients who have known risk factors for heart
failure. Monitor for signs and symptoms. If heart failure develops,
consider discontinuation of ONGLYZA.
Hypoglycemia: When ONGLYZA was used in combination with a
sulfonylurea or with insulin, the incidence of confirmed
hypoglycemia was increased over that of placebo. Consider lowering
the dose of these agents when coadministered with ONGLYZA.
Hypersensitivity Reactions: Serious reactions have been
reported in patients treated with ONGLYZA, including anaphylaxis,
angioedema, and exfoliative skin conditions. Onset of these
reactions occurred within the first 3 months after initiation of
treatment with ONGLYZA, with some reports occurring after the first
dose. If a serious hypersensitivity reaction is suspected,
discontinue ONGLYZA. Use caution in patients with a history of
angioedema to another DPP-4 inhibitor.
Severe and Disabling Arthralgia has been reported in
patients taking DPP-4 inhibitors. The time to onset of symptoms
following initiation of drug therapy varied from one day to years.
Patients experienced relief of symptoms upon discontinuation. A
subset of patients experienced a recurrence of symptoms when
restarting the same drug or a different DPP-4 inhibitor. Consider
discontinuing drug if appropriate.
Bullous Pemphigoid: There have been postmarketing reports
of bullous pemphigoid requiring hospitalization in patients taking
DPP-4 inhibitors. Tell patients to report development of blisters
or erosions. If suspected, discontinue ONGLYZA.
Macrovascular Outcomes: There have been no clinical
studies establishing conclusive evidence of macrovascular risk
reduction with ONGLYZA.
Most Common Adverse Reactions
Most common adverse reactions reported in ≥5% of patients
treated with ONGLYZA and more commonly than in patients treated
with placebo were upper respiratory tract infection (7.7%, 7.6%),
urinary tract infection (6.8%, 6.1%), and headache (6.5%,
5.9%).
Peripheral edema was reported more commonly in patients treated
with the combination of ONGLYZA 5 mg and a thiazolidinedione (TZD)
than in patients treated with the combination of placebo and TZD
(8.1% vs 4.3%, respectively).
Drug Interactions
Strong CYP3A4/5 inhibitors (eg, ketoconazole): Coadministration
with ONGLYZA significantly increases saxagliptin concentrations.
Recommend limiting ONGLYZA dosage to 2.5 mg once daily.
Use in Specific Populations
In patients with moderate or severe renal impairment, or
end-stage renal disease (eGFR <45 mL/min/1.73 m2), recommended
dosage is 2.5 mg once daily regardless of meals. ONGLYZA should be
administered following hemodialysis. Assess renal function before
starting ONGLYZA and periodically thereafter.
Please see US Full Prescribing
Information and Medication
Guide for ONGLYZA.
NOTES TO EDITORS
About AstraZeneca in Cardiovascular, Renal & Metabolism
(CVMD)
Cardiovascular, renal and metabolic diseases together form one
of AstraZeneca’s main therapy areas and platforms for future
growth. By following the science to understand more clearly the
underlying links between the heart, kidney and pancreas,
AstraZeneca is investing in a portfolio of medicines to protect
organs and improve outcomes by slowing disease progression,
reducing risks and tackling co-morbidities. Our ambition is to
modify or halt the natural course of CVMD diseases and even
regenerate organs and restore function, by continuing to deliver
transformative science that improves treatment practices and
cardiovascular health for millions of patients worldwide.
About MedImmune
MedImmune is the global biologics research and development arm
of AstraZeneca, a global, innovation-driven biopharmaceutical
business that focuses on the discovery, development and
commercialization of small molecule and biologic prescription
medicines. MedImmune is pioneering innovative research and
exploring novel pathways across Oncology, Respiratory,
Cardiovascular, Renal and Metabolic Diseases, and Infection and
Vaccines. The MedImmune headquarters is located in Gaithersburg,
Md., one of AstraZeneca’s three global R&D centers, with
additional sites in Cambridge, UK and South San Francisco, CA. For
more information, please visit www.medimmune.com.
About AstraZeneca
AstraZeneca is a global, science-led biopharmaceutical company
that focuses on the discovery, development and commercialization of
prescription medicines, primarily for the treatment of diseases in
three therapy areas – Oncology, Cardiovascular, Renal &
Metabolism and Respiratory. The Company also is selectively active
in the areas of autoimmunity, neuroscience and infection.
AstraZeneca operates in over 100 countries and its innovative
medicines are used by millions of patients worldwide. For more
information, please visit http://www.astrazeneca-us.com and follow
us on Twitter @AstraZenecaUS.
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version on businesswire.com: https://www.businesswire.com/news/home/20180619005453/en/
For AstraZeneca:Michele Meixell, 302-885-2677orAbby Bozarth,
302-885-2677
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