Category Archives: Basal Insulin

Thoughts on 2019 ADA Standards of Care

The ADA announced the publication of their 2019 Standards of Medical Care in Diabetes Care. Of note, the ADA has aligned their CVD recommendations with the ACC’s recent T2DM ASCVD recommendations. The ADA also added a new dedicated section titled “Diabetes Technology,” which includes information previously incorporated in the “Glycemic Targets” section. The ADA also provides a cost breakdown of pharmacologic treatment options. Below, FENIX has provided highlights and insights from the updated ADA 2019 Standards of Care.

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Gan and Lee + Sandoz and FDA Biosimilar Insulin BLA List

Today, Sandoz announced it has in-licensed the biosimilar insulin portfolio of Gan & Lee for commercialization of glargine, aspart, and lispro. Last week, FDA published a Q&A document and a list of biologics that will convert from NDA to BLA under the US BPCI Act of 2010, which include insulin products. Below, FENIX briefly provides thoughts on each topic.

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Mylan invalidates two Lantus patents

Today, Mylan announced the US Patent and Trademark Appeal Board (PTAB) has dismissed two of Sanofi’s Lantus patents thereby favoring Mylan/Biocon’s biosimilar glargine. Importantly, Mylan seems to indicate that it has responded to the June 2018 CRL by describing its Lantus 505(b)(2) NDA as “…under active review…” by FDA. Below, FENIX provides additional thoughts on Mylan’s announcement in the context of a tentative approval of Mylan’s bs-glargine pending its 30-month patent litigation stay with Sanofi. Recall, Mylan filed biosimilar glargine with FDA in Q3 ’17 which triggered a 30-month stay as a result of the patent infringement lawsuit filed by Sanofi. As per the PTAB ruling, Sanofi’s……

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Small Lantus Label Update

According to Drugs@FDA, the Lantus SoloStar label has been updated with changes in “Section 2.1 Dosage and Administration.” Below, FENIX provides additional details on the updated dosing instructions in comparison to the other marketed basal insulins. The updated label language (see excerpt below) includes the 1-unit dose dialing increments for the Lantus SoloStar pen. In addition to this change, a warning note has been added regarding audible clicks for visually impaired patients. Source: Lantus Solostar label from Drugs@FDA database The updated dosing instructions for unit dosage dialing and use in visually impaired patients seems to be consistent with other marketed……

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New Novo Ph2 study for QW Insulin 287 in T2DM

Last week, Novo initiated a Ph2 trial for the company’s QW basal insulin analog, “Insulin 287” (NN1436), in T2DM patients. This new trial is in line with previous guidance from Novo’s Q1 ’18 earnings call, indicating the Ph2 initiation of Insulin 287 by YE 2018 (see presentation slide below). FENIX provides thoughts on this new Ph2 T2DM trial for Insulin 287 including the use of CGM, observations about dose titration, and the potential for a Ph2 T1DM trial. Source: Novo Q1 ’18 earnings presentation Although Novo previously indicated the completion of Ph1 Insulin 287 trials, additional Ph1 studies have been observed (previous FENIX insight)…….

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Tresiba U-100 10mL vial FDA approved

According to Drugs@FDA, Novo Nordisk has received US approval for the commercialization of a 10mL vial of Tresiba U-100. Of note, Novo has not received approval for a U-200 vial. Below FENIX provides additional details on the new vial, specifically as it pertains to pediatric use.

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Thoughts on the Regulatory Environment in Diabetes

The regulatory environment in diabetes has greatly evolved in the last 10 years since the 2008 FDA CV risk guidance. As recently as ADA and now through EASD in 2018, FENIX considers the regulatory environment in the US and Europe to be highly favorable for sponsors developing diabetes drugs, devices, and technological solutions. Below, FENIX provides its perspective in a winners and losers analysis on how the highly favorable regulatory environment could be positively impactful to the key upcoming 2019 market events in diabetes from sponsors like Lexicon, Sanofi, AZ, Janssen, Novo Nordisk, Xeris, Lilly, BI, Dexcom, Senseonics, Abbott/Bigfoot, Tandem, Insulet, and Medtronic.

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REWIND Safety Issue? Lilly Q3 ’18 Earnings Update

Lilly hosted its Q3 ’18 earnings call and provided updates to its diabetes business including commentary on the recent REWIND topline results. Of note, Lilly’s first Ph3 study for its GIP/GLP dual agonist, now called tirzepatide, has been posted on CT.gov. Furthermore, Lilly said it has purchased a priority review voucher (PRV), but did not disclose how it will be used. Below, FENIX provides its new thoughts on REWIND safety, why Lilly’s PRV would be used for REWIND, and other key highlights from the earnings call.

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Mylan Q3 ’18 Earnings Update

Mylan hosted its Q3 ’18 earnings call (press release) and briefly discussed its bs-glargine. In response to an analyst’s question regarding Merck/Samsung discontinuing glargine development, Mylan affirmed they believe they can launch bs-glargine and still maintain adequate margins. Furthermore, Mylan senior management stated that they are continuing to work with FDA to find a path forward for a substitutable product.

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