Category Archives: SGLT2i

Jardiance EMPERIAL Studies Fail to Show HF Symptom Improvement

Boehringer Ingelheim and Lilly announced that the Jardiance EMPERIAL-Preserved and EMPERIAL-Reduced trials failed to meet the respective primary endpoints. Recall, these trials evaluated the impact of Jardiance on the 6-minute walk test in T2DM and non-T2DM patients with HFpEF and HFrEF. Below, FENIX provides thoughts on the failed EMPERIAL studies in the context of BI/Lilly’s ongoing EMPEROR HF outcomes studies as well as readthrough to AstraZeneca, Janssen, and Lexicon.

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Lexicon Loses Sota T1DM Formal Appeal

Lexicon Pharmaceuticals announced the FDA’s Office of New Drugs has denied Lexicon’s appeal of the CRL issued for sotagliflozin in T1DM. Lexicon’s stock fell ~15% in response to this news. In a conference call hosted shortly after the announcement, Lexicon outlined next-steps for sotagliflozin in T1DM and provided comments on additional indications and partnership opportunities. Below, FENIX provides highlights and insights from the call.

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Novo 2019 Capital Markets Day Highlights and Analysis

Novo hosted its 2019 Capital Markets Day and provided updates on the strategic direction of the company through 2025 including commercial activities and R&D strategy. Of note, Novo provided clarity on Rybelsus positioning vs. Ozempic and competitor products as well as details on novel drug delivery technologies, including two oral peptide delivery methods being developed at MIT and the semaglutide+AM833 injection device. Below, FENIX provides details and insights from the call.

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Lexicon @ Stifel; First Presentation Since Empa T1DM Adcom

Lexicon participated in the 2019 Stifel Healthcare conference and provided brief updates on the sotagliflozin regulatory situation including commentary regarding the recent BI/Lilly empa T1DM adcom. Recall, the empa T1DM adcom ended in a 2-14 vote not favoring approval. Below, FENIX provides highlights and insights from the Stifel event including potential readthrough to the ongoing sotagliflozin appeal with the Office of New Drugs.

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Janssen Jumps Into Non-T2DM HF Arena With Innovative Invokana Trial Design (CHIEF-HF) To Rival BI/LLY and AZ

Janssen announced plans to enter the SGLT2i non-T2DM HF arena with “the first-ever completely decentralized, mobile, indication-seeking clinical study” called CHIEF-HF (Canagliflozin: Impact on Health Status, Quality of Life and Functional Status in Heart Failure). According to the press release, Janssen believes it can use this new trial to support an Invokana non-T2DM heart failure (HF) indication. Of note, the trial is not yet listed on CT.gov. Below, FENIX provides thoughts on this first-of-a-kind trial design as well as insight on Janssen’s attempt to push regulatory boundaries and keep pace with BI/LLY and AZ.

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AZ’s Qtrilmet Triple-combo Receives EC Approval; New Data from Fractyl, Dario, and Valeritas

Today, a series of diabetes-related news has been observed including the EC approval of AZ’s Qtrilmet (dapa+saxa+met triple FDC)as well as new data from Fractyl, Dario, and Valeritas related to the concurrent Diabetes Technology Meeting occurring in Bethesda. Below, FENIX provides highlights and insights on the respective news items.

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AZ Initiates Unbranded HF Education Campaign

AstraZeneca announced the initiation of a new unbranded disease state education (DSE) campaign called “Diabetes Can Break Your Heart,” which focuses on heart failure (HF) risk in patients with T2DM. The DSE includes a new website as well as a national bus tour that will stop at select cities throughout 2020 but starts in Philadelphia at the upcoming AHA conference (November 16-18). Below, FENIX provides insights about the new AZ HF campaign including a comparison to BI/Lilly’s initial Jardiance DSE for its CV death risk reduction indication.

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Empa T1DM FDA Adcom Overwhelmingly Negative (2-14); Is SGLTi in T1DM Approvable in the US?

Today, FDA held an advisory committee meeting to discuss the benefit/risk profile of 2.5mg empagliflozin for the treatment of T1DM. Somewhat surprisingly, the panel voted overwhelmingly against (2-14) the approval of 2.5mg empa based on the currently characterized benefit/risk profile and small amount of supporting data. BI/Lilly subsequently issued a press release regarding the outcome of the adcom. Below, FENIX provides insight into the future of SGLTi therapy in T1DM including implications to BI/Lilly, AZ, and Lexicon.

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BI/Lilly Initiate Jardiance Acute HF Study (EMPULSE)

BI/Lilly announced the initiation of a new Jardiance study (EMPULSE) in T2DM and non-T2DM patients who have been hospitalized for acute heart failure. Below, FENIX provides an overview of the trial as well as insights into how the EMPULSE trial appears to be a natural progression of BI/Lilly’s Jardiance LCM strategy.

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Empa T1DM Adcom Could Be Easier Than Sota, But Still Difficult; Briefing Documents Analysis

Briefing documents for the BI/Lilly empagliflozin T1DM FDA adcom were posted today in advance of the November 13, 2019 meeting. Interestingly, BI/Lilly is only pursuing approval for the low, 2.5mg dose of empagliflozin, which demonstrated less DKA but also lower efficacy. Questions around the 2.5mg dose and its limited clinical data are likely to be the center of the adcom discussion. Below, FENIX provides thoughts on the empa T1DM adcom including analysis of the benefit/risk ratio, proposed risk mitigation strategy, and adcom panelists (9 of whom were also on the sota adcom).

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