Wednesday 3 February 2016

Drug Trials Snapshot: RYZODEG, Review by Jaikumar pareta

What is the drug for?

RYZODEG is a mixture of a long-acting insulin and fast-acting insulin that improves blood sugar control in adults with diabetes mellitus (DM). It can be used in patients with type 1 or type 2 DM.

How is this drug used?

RYZODEG is available as a liquid that comes in a prefilled pen. It is injected once daily under the skin (subcutaneously).

What are the benefits of this drug?

In patients with type 1 and type 2 who need better blood sugar control, treatment with RYZODEG can lower HbA1c (hemoglobin A1c, which is a measure of blood sugar control). RYZODEG’s ability to lower HbA1c is in line with other, previously approved long-acting or pre-mixed (combination of long-acting and fast-acting) insulin products on the market.

Were there any differences in how well the drug worked in clinical trials among sex, race and age?

Subgroup analyses were conducted for sex, race and age.
  • Sex:  RYZODEG worked similarly in men and women.
  • Race:  In patients with type 1 DM, RYZODEG worked similarly in Whites and Black or African Americans.  There were too few Asian patients with type 1 DM to determine whether they responded differently to RYZODEG. In patients with type 2 DM, RYZODEG worked similarly among all racial groups studied.
  • Age: RYZODEG worked similarly in patients below and above 65 years of age.

What are the possible side effects?

The most common side effects were low blood sugar (hypoglycemia), allergic reactions, injection site reactions, pitting at the injection site (lipodystrophy), itching, rash, swelling, and weight gain.

Were there any differences in side effects among sex, race and age?

Subgroup analyses were conducted for sex, race and age.
  • Sex:  The risk of side effects was similar in men and women.
  • Race:  In patients with type 1 DM, the majority of patients were white. Differences in side effects among races could not be determined. In patients with type 2 DM, the majority of patients were white and Asian. The risk of side effects was similar in Whites and Asians. Differences in side effects among other races could not be determined.
  • Age: The risk of side effects was similar in patients below and above 65 years of age.

WHO WAS IN THE CLINICAL TRIALS?

Who participated in the clinical trials?

The FDA approved RYZODEG based on evidence from 1 clinical trial of 548 patients with type 1 DM and 4 clinical trials in 1860 patients (total) with type 2 DM.
Figure 1 summarizes how many men and women were enrolled in the clinical trials used to evaluate efficacy. Figure 1 includes the trials of patients with type 1 DM, and Figure 2 includes the trials of patients with type 2 DM.
Figure 1. Patients with Type 1 DM by Sex (Total Patients=548)
Pie chart summarizing how many men and women were enrolled in the clinical trial used to evaluate efficacy of the drug RYZODEG for patients with Type 1 DM.  In total, 272 men (50%) and 276 women (50%) participated in the clinical trial used to evaluate efficacy of the drug RYZODEG for patients with Type 1 DM.  Clinical Trial Data
Figure 2. Patients with Type 2 DM by Sex (Total Patients=1860)
Pie chart summarizing how many men and women were enrolled in the clinical trial used to evaluate efficacy of the drug RYZODEG for patients with Type 2 DM.  In total, 1001 men (54%) and 859 women (46%) participated in the clinical trial used to evaluate efficacy of the drug RYZODEG for patients with Type 2 DM.
Clinical Trial Data
The figures below summarize how many patients by racial group participated in the clinical trials used to evaluate efficacy. Figure 3 includes the trials of patients with type 1 DM, and Figure 4 includes the trials of patients with type 2 DM.
Figure 3. Patients with Type 1 DM by Racial Group
 Pie chart summarizing the percentage of patients by race enrolled in the RYZODEG clinical trial for patients with Type 1 DM. In total, 495 Whites (90%), 7 Asians (1%), 16 Black or African American (3%), and 30 Other (5%) participated in the clinical trial for patients with Type 1 DM.
Clinical Trial Data
Table 1. Demographics of Efficacy Trials by Race-Patients with Type 1 DM
RaceNumber of PatientsPercentage
White49590%
Black or African American163%
Asian71%
Other305%
Figure 4. Patients with Type 2 DM by Racial Group
Pie chart summarizing the percentage of patients by race enrolled in the RYZODEG clinical trial for patients with Type 2 DM. In total, 878 Whites (47%), 900 Asians (48%), 72 Black or African American (4%), and 10 Other (1%) participated in the clinical trial for patients with Type 2 DM.
Clinical Trial Data
Table 2. Demographics of Efficacy Trials by Race—Patients with Type 2 DM
RaceNumber of PatientsPercentage
White87847%
Black or African American724%
Asian90048%
Other101%
Clinical Trial Data
The figures below summarize how many patients by age group (at the start of the trials) participated in the clinical trials for type 1 patients (Figure 5) and type 2 patients (Figure 6).
Figure 5. Trials of Patients with Type 1 DM by Age Group
Pie chart summarizing the percentage of patients by race enrolled in the RYZODEG clinical trial for patients with Type 1 DM.  In total, 523 participants were below 65 years old (95%) and 25 participants were 65 and older (5%).
Clinical Trial Data
Figure 6. Trials of Patients with Type 2 DM by Age Group
Ryzodeg Figure 6
Clinical Trial Data

How were the trials designed?

The benefits and side effects of RYZODEG 70/30 administered once-daily with the main meal of the day in patients with type 1 diabetes was evaluated in one randomized, open-label, treat-to-target, active-controlled trial. In this trial, patients were randomly assigned to either receive RYZODEG 70/30 once-daily administered at the main meal of the day and a mealtime insulin at remaining meals or another long-acting insulin once or twice daily combined with rapid-acting insulin at meals.
RYZODEG 70/30 administered once or twice daily with the main meal(s) in patients with type 2 diabetes when used with common oral anti-diabetic drugs was evaluated in four randomized, open-label, treat-to-target, active-controlled trials. In these trials, patients were randomized to RYZODEG 70/30 once-daily at breakfast or another long-acting or pre-mixed insulin once-daily according to approved labeling. Metformin, an oral medication, was given in both arms.
In each trial, the change in HbA1c from the start to finish of the trial was measured.

GLOSSARY

CLINICAL TRIAL: Voluntary research studies conducted in people and designed to answer specific questions about the safety or effectiveness of drugs, vaccines, other therapies, or new ways of using existing treatments.
COMPARATOR: A previously available treatment or placebo used in clinical trials that is compared to the actual drug being tested.
EFFICACY: How well the drug achieves the desired response when it is taken as described in a controlled clinical setting, such as during a clinical trial.
PLACEBO: An inactive substance or “sugar pill” that looks the same as, and is given the same way as, an active drug or treatment being tested. The effects of the active drug or treatment are compared to the effects of the placebo.
SUBGROUP: A subset of the population studied in a clinical trial. Demographic subsets include sex, race, and age groups.





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