Latest type 2 diabetes drug achieves good blood results

SURPASS Phase 3 trials published in 2021 prove that tirzepatide lowers blood sugar and supports weight loss better than other medications for type 2 diabetes (T2D) [1]. New research evaluating the time it takes to reach blood glucose goals indicates that tirzepatide also achieves goals for blood sugar control and weight loss faster than current diabetes medications.

The latest analyzes of the SURPASS-2 and SURPASS-3 trials, presented at this year’s European Association for the Study of Diabetes (EASD) annual meeting in Stockholm, Sweden (September 19-23), found that adults treated with different doses of injectable tirzepatide reached ( 5, 10, and 15 mg) to blood glucose targets about four weeks before those taking injectable semaglutide (1 mg), and four to 12 weeks before those taking once-daily insulin (degludec; iDeg), along with Combined with diet, exercise, and oral glucose-lowering medications.

“Tirzepatide is unique in that it mimics two natural hormones that release insulin and suppress appetite in a single injection,” says lead author Dr Adie Viljoen, Consultant Metabolic and Chemopathologist from East and North Hertfordshire NHS Trust, UK. “The speed we see is lowering glucose and losing weight more than anything else available to us now and may put adults with type 2 diabetes in a better position to prevent long-term complications. But it is important to remember that these medications should be used in addition to diet and exercise. Sports. “

T2D is a chronic, advanced condition in which the body does not make or use insulin normally, resulting in high blood glucose levels. More than 30 million Americans have T2D, but despite the availability of many medications to treat diabetes, only about half of American adults with T2D achieve target hemoglobin A1c (HbA1c; a measure of blood sugar control) below 7%. [2]. High HbA1c levels are associated with complications such as heart disease, stroke, kidney disease (nephropathy), eye disease (retinopathy), and nerve disease (neuropathy).

Terzipatide is a single molecule belonging to a new class of diabetes drugs that mimic two types of hormones, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), involved in the control of blood sugar and appetite suppression. It was approved for the treatment of T2D by the US Food and Drug Administration in May 2022.

The SURPASS-2 and SURPASS-3 trials compared different doses of tirzepatide (5, 10, and 15 mg) with weekly injectable semaglutide 1 mg (a single hormone, GLP-1 mimic) as an add-on to metformin, or long-acting insulin (iDeg) , as add-on therapy to metformin with or without a sodium-glucose cotransporter-2 inhibitor, respectively [3].

On average, participants treated with all doses of tirzepatide lowered their HbA1c more than those treated with semaglutide and iDeg, and the largest had an HbA1c of less than 7% (<53 mmol/mol), less than or equal to 6.5% ( ≤48 mmol/mol), and less than 5.7% (<39 mmol/mol) at 40 weeks (SURPASS-2) and 52 weeks (SURPASS-3), respectively.

In this latest analysis comparing time to reach HbA1c goals from the start of the study, researchers found that participants who took tirzepatide reached HbA1c goals less than 7% and 6.5% or less faster than both semaglutide and iDeg (see table in Notes to Editors ).

The median (median) time to achieve an HbA1c level of <7% was approximately 8 weeks for all tirzepatide doses compared to 12 weeks for both semaglutide and iDeg; And to get to 6.5% or less was 12 weeks versus about 16 and 24 weeks, respectively.

Further analyzes of SURPASS-2 found that participants treated with tirzepatide also reached weight loss goals significantly faster than semaglutide. The median time to reach 5% or more weight loss was approximately 12 weeks on the two higher doses of tirzepatide (10 and 15 mg) compared to 24 weeks for semaglutide (see table in notes to editors).

“Even a small weight loss of 5% of initial body weight is associated with clinically significant improvements in weight-related health issues for many individuals,” says Viljoen. “For people with type 2 diabetes, their ability to achieve these improvements in health in about half the time is incredible.”

Mild to moderate gastrointestinal side effects such as nausea, vomiting and diarrhea were observed in participants who took tirzepatide and were reported frequently during the dose escalation period and decreased over time.

The authors acknowledge several limitations of the study, including that the studies were not specifically designed to compare rate of glycemic control and weight loss, and therefore these analyzes should be interpreted with caution.

For interviews with the report’s authors, please contact Dr Adi Filjoen, East and North Hertfordshire NHS Trust, UK e) adie.viljoen@nhs.net T) +44 (0) 7988 016781

Alternative contact in the EASD press room: Tony Kirby T) + 44 (0) 7834 385827 E) tony@tonykirby.com

This study was funded by Eli Lilly and Company.

The authors received grants from Sanofi and further lecture/fee from Novartis, Boehringer Ingelheim, and Napp. Non-financial support was also provided by Lilly, Novo Nordisk and AstraZeneca.

Twitter (to see when the ban will be lifted): EASDnews

Notes to editors:

[1] https://www.nejm.org/doi/pdf/10.1056/NEJMoa2107519
tirzepatide once per week versus insulin degludec once daily as an add-on to metformin with or without SGLT2 inhibitors in patients with type 2 diabetes (SURPASS-3): a randomized, open-label, parallel group trial, Phase 3 – The Lancet
[2] Public health implications of recommendations for customizing glycemic goals in adults with diabetes (nih.gov)
[3] In SURPASS-2 and 3, tirzepatide was started at a dose of 2.5 mg once weekly, and doses were increased by 2.5 mg every 4 weeks until the randomly assigned dose was reached and maintained for the duration of the trial. Semaglutide was started at a dose of 0.25 mg once weekly, and the dose was doubled every 4 weeks until 1 mg was reached and maintained throughout the trial. Insulin degludec was started at 10 units/day and titrated weekly to a fasting blood glucose level <5.0 mmol/L following the goal therapy algorithm.

This press release is based on the 591 summary of the European Association for the Study of Diabetes (EASD). All widely accepted abstracts were reviewed by the conference selection committee. There is no complete research paper at this point, but the authors are happy to answer your questions. The research has not yet been submitted to a medical journal for publication. As this is an oral presentation, there is no poster available.

Table: Summary of time to reach HbA1c goals and weight loss limits

TZP 5 mg

TZP 10 mg

TZP 15 mg

Comparative

SURPASS-2 TZP vs. semaglutide 1 mg – ADD TO MET

n = 470 (TZP 5 mg), 469 (TZP 10 mg), 469 (TZP 15 mg), 468 (semaglutide)*

HbA1c <53 mmol/mol (7%)

Average time to reach the goal first (week)

8.1

8.1

8.1

12.0

HR (95% CI)

1.3 (1.1, 1.4)

1.4 (1.2, 1.6)

1.4 (1.2, 1.6)

– –

HbA1c ≤ 48 mmol/mol (6.5%)

Average time to reach the goal first (week)

12.1

12.1

12.1

15.7

HR (95% CI)

1.2 (1.1, 1.4)

1.6 (1.4, 1.8)

1.6 (1.4, 1.9)

– –

Weight loss ≥5%

Average time to reach the goal first (week)

16.0

12.4

12.4

24

HR (95% CI)

1.5 (1.3, 1.8)

2.1 (1.8, 2.4)

2.2 (1.9, 2.6)

– –

SURPASS-3 TZP vs. titrated insulin degludec – add to MET or MET + SGLT2i

n = 358 (TZP 5 mg), 360 (TZP 10 mg), 358 (TZP 15 mg), 359 (insulin degludec)*

HbA1c <53 mmol/mol (7%)

Average time to reach the goal first (week)

8.1

8.1

8.1

12.1

HR (95% CI)

1.7 (1.5, 2.1)

1.8 (1.5, 2.1)

1.9 (1.6, 2.3)

– –

HbA1c ≤ 48 mmol/mol (6.5%)

Average time to reach the goal first (week)

12.1

12.1

12.1

24.1

HR (95% CI)

2.2 (1.8, 2.6)

2.4 (2.0, 2.8)

2.6 (2.2, 3.1)

– –

* Modification of intention to treat population (efficacy analysis group). on treatment data listed before using rescue therapy.

CI = confidence interval; HR = Hazard Ratio; MET = metformin; SGLT2i = sodium/glucose transporter-2 inhibitor; TZP = terzepeptide; opposite = opposite


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