- 76% Higher Dose of Insulin detemir Needed to Achieve Similar, Well
Tolerated Glycemic Control Versus Lantus(R)
PARIS, Sept. 30 /CNW/ - Sanofi-aventis (EURONEXT: SAN and NYSE: SNY) announced today results of a head-to-head study providing further evidence on the efficacy of once-daily, 24-hour basal insulin Lantus(R) (insulin glargine (rDNA) injection) compared to twice-daily insulin detemir. The study was presented during the 45th Annual Meeting of the European Association for the Study of Diabetes (EASD) in Vienna.
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In the head-to-head, randomised, non-inferiority controlled clinical trial of 964 patients, patients taking Lantus(R) required an average daily dose of 43.5 units to achieve the primary endpoint of HbA1c below 7% without symptomatic hypoglycaemia compared to patients on insulin detemir, who received 76.5 units - an increase of 76% (p(less than)0.001). Despite lower doses of insulin in the glargine group, Lantus(R) once-daily and insulin detemir twice-daily resulted in similar improvements in glycemic control (HbA1c) and a similar risk of hypoglycaemia (primary endpoint: 27.5% vs 25.6%, p=0.52). Patients in the Lantus(R) arm of the study also achieved significantly lower fasting blood glucose (-63.1 mg/dL Lantus(R) vs -57.7 mg/dL, p(less than)0.001).
"This study demonstrated that for insulin-naive patients with type 2 diabetes, initiating insulin therapy with once-daily glargine achieved the same glycemic control as twice-daily detemir, with somewhat more weight gain, but lower insulin doses", stated Study Investigator Hertzel Gerstein, Professor of Diabetes Medicine, Faculty of health sciences, Hamilton, Canada.
In the study, patients taking Lantus(R) once-daily reported a significantly greater treatment satisfaction over insulin detemir twice-daily, with over 50% less drop-outs (4.6% vs 10.1%, p=0.001). Discontinuations in patients taking insulin detemir were primarily due to adverse events, including skin reactions. Whilst a similar rate of overall hypoglycaemia and nocturnal hypoglycaemia was observed in both arms, patients on Lantus(R) once-daily experienced less daytime hypoglycaemia as compared to insulin detemir (1.06 vs 1.64 events per patient year, p=0.046). Patients on insulin detemir experienced less weight gain (0.6 vs 1.4 kg, difference 0.77 kg, p(less than)0.001).
About the Lantus(R) vs. insulin detemir study(1)
In the study, a total of 964 insulin-naive patients were examined. Patients were between 40 to 75 years of age and had type 2 diabetes for at least 1 year with sub-optimal blood glucose control using glucose-lowering drugs.
Patients were randomised and treated with Lantus(R) once daily, at either dinner or bedtime, or insulin detemir twice daily, both at breakfast and before dinner, along with stable doses of metformin. Thiazolidinedione treatment was halted as of insulin randomisation, but insulin secretagogues were continued or discontinued at the investigator's discretion.
For both insulins, the starting daily dose was 0.2 U/kg, which was then titrated every 2 days by 2 units to obtain a Fasting Plasma Glucose (FPG) of (less than)100 mg/dL (5.6 mmol/L). At baseline, mean age was 58.4 plus or minus 8.3 yrs (mean plus or minus standard deviation), mean type 2 diabetes duration was 9.9 plus or minus 5.8 years, mean FPG was 189.2 plus or minus 48.7 mg/dL, and mean HbA1c was 8.7 plus or minus 0.9%. 27.5% and 25.6% of patients reached the primary endpoint of HbA1c (less than)7% without confirmed hypoglycaemia. Change from baseline to endpoint HbA1c was similar with Lantus(R) and insulin detemir (-1.46 plus or minus1.09 and -1.54 plus or minus 1.11%; p=0.149), endpoint HbA1c levels were 7.2 plus or minus 0.9% and 7.1 plus or minus 0.9% respectively. Endpoint FBG was lower with Lantus(R) versus insulin detemir (108 plus or minus 24 vs 119 plus or minus 32mg/dL).
There was a lower rate of daytime symptomatic hypoglycaemia confirmed by PG less than or equal to 56 mg/dL (3.1 mmol/L) with Lantus(R) treatment vs. insulin detemir (1.06 plus or minus 3.13 vs. 1.64 plus or minus 5.42 events/patients-year, p=0.046). Frequencies of asymptomatic, overall symptomatic, nocturnal symptomatic and severe hypoglycaemia were comparable between treatment groups. Significantly more patients in the insulin detemir group terminated the study early (10.1 vs. 4.6%, p=0.001), which was mostly related to skin reactions. Limited weight gain in both groups, although compared with the glargine group, patients on insulin detemir experienced less weight gain (0.6 versus 1.4kg, difference 0.77kg p(less than)0.001).
Lantus(R) is indicated for once-daily subcutaneous administration in the treatment of adult patients with type 2 diabetes mellitus who require basal (long-acting) insulin for the control of hyperglycaemia and for adult and paediatric patients (6 years and older) with type 1 diabetes mellitus. Lantus(R) demonstrates a peakless and sustained concentration/time profile over 24h thus reducing the risk of hypoglycaemia and allowing a constant and high efficacy over 24h with one single day injection. Lantus(R) is the number one prescribed insulin worldwide.
Diabetes is a chronic, widespread condition in which the body does not produce or properly use insulin, the hormone needed to transport glucose (sugar) from the blood into the cells of the body for energy. More than 230 million people worldwide are living with the disease and this number is expected to rise to a staggering 350 million within 20 years. It is estimated that nearly 24 million Americans have diabetes, including an estimated 5.7 million who remain undiagnosed. In addition, about 40 percent of those diagnosed are not achieving the blood sugar control target of HbA1c (less than) 7 percent recommended by the ADA. The HbA1c test measures average blood glucose levels over the past two- to three-month period.
Sanofi-aventis, a leading global pharmaceutical company, discovers, develops and distributes therapeutic solutions to improve the lives of everyone. Sanofi-aventis is listed in Paris (EURONEXT: SAN) and in New York (NYSE: SNY).
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(1) S.G.H. Swinnen, et al. Abstract 966. "Once-daily insulin glargine requires a significantly lower dose than insulin detemir twice-daily to achieve good glycaemic control in patients with type 2 diabetes failing oral therapy"
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