AZ success with novel diabetes combo

AstraZeneca has unveiled results which show a novel combination of its weekly injectable Bydureon and daily pill Forxiga can help diabetes patients control their condition better than either treatment alone.

The DURATION-8 trial is the first to combine a GLP-1 drug such as Bydureon with an SGLT2 inhibitor like Forxiga, and could be a new option in oral treatment instead of progressing onto insulin.

The company is pushing to gain a greater share of the type 2 diabetes market, which is currently dominated by Merck’s oral treatment Januvia, Sanofi’s basal insulin Lantus and Novo Nordisk’s GLP-1 receptor agonist Victoza.

The DURATION-8 trial achieved its primary endpoint with the combination of Bydureon (exenatide) and Forxiga (dapagliflozin) significantly reducing HbA1c from baseline compared with exenatide or dapagliflozin alone - 1.95% versus 1.58% and 1.37% respectively both at 28 weeks.

This means the combination helped more of these patients bring their blood glucose under control (below 7·0% HbA1c ). However the magnitude of this combined effect is not overwhelming, and leaves plenty of space for rival combinations, such as SGLT2s combined with the well-established DPP-4 class.

Also presenting at the European Association for the Study of Diabetes (EASD) in Munich this week were Merck (MSD in Europe) and Pfizer.

They released a phase 3 study of Merck’s DPP-4 drug Januvia combined with a new SGLT2 contender ertugliflozin.

Both 5 mg and 15 mg daily doses of the drug showed significantly greater reductions in A1C of 0.69 percent and 0.76%, respectively, compared with placebo when added to patients on a background of Januvia (sitagliptin) and stable metformin.

Both the AZ and the Merck/Pfizer combinations showed greater weight loss in patients and reductions in systolic blood pressure compared to placebo.

SGLT2 drugs are increasingly gaining ground in the market, most notably Lilly and Boehringer Ingelheim’s Jardiance, which last year became the first diabetes drug to show it can cut heart attacks and strokes.

Meanwhile, Novo Nordisk’s GLP-1 drug Victoza has also shown similar benefits. AstraZeneca could therefore be in a very strong position, if future trials show that combining these two drugs classes also produces extra cardiovascular benefits over and above either drug on its own.