New Post-Hoc Analysis of Pooled Phase 3 Data Shows That INPEFA® (Sotagliflozin) Reduced Risk of Heart Failure Events in Patients With Preserved Ejection Fraction

Rhea-AI Summary

Lexicon Pharmaceuticals announced a new post-hoc analysis of pooled Phase 3 data showing that INPEFA® (sotagliflozin), a dual oral inhibitor of SGLT2 and SGLT1, significantly reduced the risk of heart failure events in patients with preserved ejection fraction (HFpEF). The analysis, presented at the Heart Failure Association of the European Society of Cardiology Congress, highlighted INPEFA's effectiveness in patients with obesity-related HFpEF. Data from the SOLOIST-WHF and SCORED trials involving 1,932 patients indicated that age, sex, and BMI were important risk factors. Notably, older patients and those with higher BMI saw a greater reduction in primary endpoint events with INPEFA compared to placebo. The findings emphasize the need for personalized treatment strategies for HFpEF patients.

Positive

• INPEFA reduces the risk of heart failure events in HFpEF patients.
• Effective in patients with obesity-related HFpEF phenotype.
• Analysis based on robust data from SOLOIST-WHF and SCORED trials.
• Involves a diverse patient population (1,932 patients).
• Favorable response in patients with BMI ≥ 30 kg/m².
• Presentation at a prestigious ESC congress adds credibility.
• Highlights the importance of personalized treatment strategies.

Negative

• INPEFA increases the risk of ketoacidosis, particularly in type 1 diabetes patients.
• Volume depletion and symptomatic hypotension are potential side effects.
• Increased risk of urinary tract infections, including severe cases requiring hospitalization.
• Risk of genital mycotic infections.
• Potential drug interactions with digoxin, rifampicin, and lithium.
• Not recommended during pregnancy and lactation.
• efficacy data in patients with severe renal and hepatic impairment.

Insights

Medical Research Analyst

The post-hoc analysis of INPEFA highlights its efficacy in reducing heart failure events among patients with preserved ejection fraction (HFpEF), especially those with obesity-related HFpEF. This is particularly important because HFpEF has been a challenging condition to manage effectively, with limited treatment options available. The fact that INPEFA showed substantial benefits in this subgroup suggests it could play a significant role in addressing a growing medical need, especially given the increasing prevalence of obesity and type 2 diabetes.

Patients with HFpEF often have a preserved left ventricular ejection fraction (LVEF), making their heart unable to fill properly despite the muscle being strong. Hence, effectively managing this condition can significantly impact patients' quality of life and reduce hospitalizations.

This analysis strengthens INPEFA's profile as a dual inhibitor of SGLT1 and SGLT2, which are important in glucose regulation. However, it's important to note the safety concerns such as ketoacidosis and volume depletion, which require careful patient monitoring. These safety issues necessitate a balanced assessment when considering this medication for broader use in diverse patient populations.

Financial Analyst

This analysis of INPEFA's efficacy could positively impact Lexicon Pharmaceuticals' market position. The data showing reduced heart failure events, particularly in high-risk subgroups, may lead to increased adoption of INPEFA, potentially driving revenue growth. Heart failure treatments represent a significant market and a new effective therapy could capture substantial market share, especially given the dual-inhibitory mechanism which is relatively unique.

From a financial perspective, the expanded evidence of INPEFA’s benefits can strengthen Lexicon’s negotiating position with payers and healthcare providers, potentially leading to better reimbursement rates. Moreover, positive clinical outcomes could foster investor confidence, supporting stock price appreciation in the short to medium term.

However, investors should be cautious about potential downside risks such as safety concerns and regulatory scrutiny, which could impact the medication’s marketability. Additionally, competitive pressure from other SGLT2 inhibitors might limit growth.

Analysis adds to the body of evidence differentiating INPEFA as a dual oral inhibitor of SGLT2 and SGLT1

THE WOODLANDS, Texas, May 14, 2024 (GLOBE NEWSWIRE) -- Lexicon Pharmaceuticals, Inc. (Nasdaq: LXRX) today announced a new post-hoc analysis of clinical data showing that INPEFA^® (sotagliflozin), a dual oral inhibitor of SGLT2 and SGLT1, reduced the risk of heart failure-related events across a diverse population of patients, including patients with preserved ejection fraction (HFpEF). Researchers noted that INPEFA appeared to be particularly effective in reducing the risk of heart failure events in patients with an obesity-related HFpEF phenotype. These findings, based on a pooled, patient-level analysis of data from the SOLOST-WHF and SCORED pivotal clinical trials, were presented today at the Annual Congress of the Heart Failure Association of the European Society of Cardiology (ESC) in Lisbon, Portugal.

Obesity and type 2 diabetes (T2D), along with a growing aging population, is contributing to the escalating prevalence of HFpEF. Recent data published in journals of the American College of Cardiology and the American Heart Association suggest that individuals with an obesity-related HFpEF phenotype represent a distinctive and clinically significant subgroup from those with standard HFpEF phenotype. This new analysis assessed the impact of obesity, along with sex and age, on the effects of INPEFA on the primary composite endpoint of cardiovascular (CV) death and heart failure (HF) events in patients with left ventricular ejection fraction (LVEF) ≥ 50%. Previously, SOLOIST-WHF and SCORED data demonstrated that INPEFA, a dual oral inhibitor of SGLT2 and SGLT1, is effective in reducing the risk of CV death and HF-related outcomes across the LVEF range.

Data from a total of 1,932 patients were included in the analysis (mean age: 69.9 years, mean BMI: 34.1 kg/m²; mean HbA1c:8.5%). In this population, 18.1% of patients experienced a primary endpoint event. Males and females demonstrated comparable event rates, 18.3% and 18.0% respectively; however, older age (< 65: 10.9% vs. ≥ 65years: 20.3%) and higher BMI (< 30 kg/m²: 16.6% vs. ≥ 30 kg/m²: 18.7%) were associated with an increased number of patients at risk for primary endpoint events.

Within the subgroup characterized by higher BMI, INPEFA therapy resulted in a favorable response for patients with BMI ≥ 30 kg/m² (p-value for interaction 0.038). Researchers also noted that both sex and age subgroups had a consistent response to INPEFA (p-value for interaction 0.818 and 0.393, respectively).

“This analysis underscores the importance of identifying patient risk factors such as age, sex, and obesity in patients with HFpEF and adds to the body of evidence differentiating INPEFA as a dual inhibitor of SGLT1 and SGLT2,” said Craig Granowitz, M.D., Ph.D., Lexicon’s senior vice president and chief medical officer. “Additionally, today’s data presentation further highlights the benefits of INPEFA in reducing the risk of heart failure-related events across a wide range of patients with HFpEF, including in patients with an obesity-related HFpEF phenotype.”

About INPEFA^® (sotagliflozin)
Discovered using Lexicon’s unique approach to gene science, INPEFA^® (sotagliflozin) is an oral inhibitor of two proteins responsible for glucose regulation known as sodium-glucose cotransporter types 2 and 1 (SGLT2 and SGLT1). SGLT2 is responsible for glucose and sodium reabsorption by the kidney and SGLT1 is responsible for glucose and sodium absorption in the gastrointestinal tract. Sotagliflozin has been studied in multiple patient populations encompassing heart failure, diabetes, and chronic kidney disease in clinical studies involving approximately 20,000 patients.

INDICATION
INPEFA is indicated to reduce the risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visit in adults with:

• heart failure or
• type 2 diabetes mellitus, chronic kidney disease, and other cardiovascular risk factors
  

IMPORTANT SAFETY INFORMATION

Dosing: Assess renal function and volume status and, if necessary, correct volume depletion prior to initiation of INPEFA. INPEFA dosing for patients with decompensated heart failure may begin when patients are hemodynamically stable, including when hospitalized or immediately upon discharge.

Contraindications: INPEFA is contraindicated in patients with hypersensitivity to INPEFA or any of its components.

Ketoacidosis: INPEFA increases the risk of ketoacidosis in patients with type 1 diabetes mellitus (T1DM). Type 2 diabetes Mellitus (T2DM) and pancreatic disorders are also risk factors. The risk of ketoacidosis may be greater with higher doses. There have been postmarketing reports of fatal events of ketoacidosis in patients with type 2 diabetes using sodium glucose transporter 2 (SGLT2) inhibitors. Before initiating INPEFA, assess risk factors for ketoacidosis. Consider ketone monitoring in patients with T1DM and consider ketone monitoring in others at risk for ketoacidosis and educate patients on the signs/symptoms of ketoacidosis. Patients receiving INPEFA may require monitoring and temporary discontinuation of therapy in clinical situations known to predispose to ketoacidosis. INPEFA is not indicated for glycemic control.

Assess patients who present with signs and symptoms of metabolic acidosis or ketoacidosis, regardless of blood glucose level. If suspected, discontinue INPEFA, evaluate, and treat promptly. Monitor patients for resolution of ketoacidosis before restarting INPEFA.

Volume Depletion: INPEFA can cause intravascular volume depletion which may sometimes manifest as symptomatic hypotension or acute transient changes in creatinine. There have been post-marketing reports of acute kidney injury, some requiring hospitalization and dialysis, in patients with type 2 diabetes mellitus receiving SGLT2 inhibitors. Patients with impaired renal function (eGFR < 60 mL/min/1.73 m2), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. Before initiating INPEFA in patients with one or more of these characteristics, assess volume status and renal function, and monitor for signs and symptoms of hypotension during therapy.

Urosepsis and Pyelonephritis: Treatment with SGLT2 inhibitors, including INPEFA, increases the risk for urinary tract infections. Serious urinary tract infections including urosepsis and pyelonephritis requiring hospitalization have been reported. Evaluate patients for signs and symptoms of urinary tract infections and treat promptly.

Hypoglycemia with Concomitant Use with Insulin and Insulin Secretagogues: Insulin and insulin secretagogues are known to cause hypoglycemia. INPEFA may increase the risk of hypoglycemia when combined with insulin or an insulin secretagogue. Therefore, a lower dose of insulin or insulin secretagogue may be required to minimize the risk of hypoglycemia when used with INPEFA.

Necrotizing Fasciitis of the Perineum (Fournier’s Gangrene): Reports of Fournier’s Gangrene, a rare but serious and life-threatening necrotizing infection requiring urgent surgical intervention, have been identified in post-marketing surveillance in patients with diabetes mellitus receiving SGLT2 inhibitors. Assess patients who present with pain, tenderness, erythema, or swelling in the genital or perineal area, along with fever or malaise. If suspected, start treatment immediately with broad-spectrum antibiotics and, if necessary, surgical debridement. Discontinue INPEFA, closely monitor patient signs and symptoms, and provide appropriate alternative therapy for heart failure.

Genital Mycotic Infections: INPEFA increases the risk of genital mycotic infections. Monitor and treat as appropriate.

Urinary Glucose Test and 1,5-anhydroglucitol (1,5-AG) Assay: these are not reliable for patients taking SGLT2 inhibitors. Use alternative testing methods to monitor glucose levels.

Common Adverse Reactions: the most commonly reported adverse reactions (incidence ≥ 5%) were urinary tract infection, volume depletion, diarrhea, and hypoglycemia.

Drug Interactions:

• Digoxin: Monitor patients appropriately as there is an increase in the exposure of digoxin when coadministered with INPEFA 400 mg.

• Uridine 5'-diphospho-glucuronosyltransferase (UGT) Inducer: The coadministration of rifampicin, an inducer of UGTs, with sotagliflozin resulted in a decrease in the exposure of sotagliflozin.

• Lithium: Concomitant use of an SGLT2 inhibitor with lithium may decrease serum lithium concentrations. Monitor serum lithium concentration more frequently during INPEFA initiation and with dosage changes.
  

Use in Specific Populations:

• Pregnancy and Lactation: INPEFA is not recommended during the second and third trimesters of pregnancy, nor while breastfeeding.

• Geriatric Use: No INPEFA dosage change is recommended based on age. No overall differences in efficacy were detected between these patients and younger patients, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. Elderly patients may be at increased risk for volume depletion adverse reactions, including hypotension.

• Renal Impairment: INPEFA was evaluated in patients with chronic kidney disease (eGFR 25 to 60 mL/min/1.73 m²) and in patients with heart failure with eGFR < 60 mL/min/1.73 m². The safety profile of INPEFA across eGFR subgroups in these studies was consistent with the known safety profile. There was an increase in volume-related adverse events (e.g., hypotension, dizziness) in patients with eGFR < 30 mL/min/1.73m² relative to the overall safety population. Efficacy and safety studies with INPEFA did not enroll patients with an eGFR less than 25 mL/min/1.73 m² or on dialysis. After starting therapy in the studies, patients were discontinued if eGFR fell below 15 mL/min/1.73 m² or were initiated on chronic dialysis.

• Hepatic Impairment: INPEFA is not recommended in patients with moderate or severe hepatic impairment.
  

Click here for full Prescribing Information.

https://www.lexpharma.com/inpefa-US-PI.pdf

About Lexicon Pharmaceuticals
Lexicon is a biopharmaceutical company with a mission of pioneering medicines that transform patients’ lives. Through the Genome5000™ program, Lexicon’s unique genomics target discovery platform, Lexicon scientists studied the role and function of nearly 5,000 genes and identified more than 100 protein targets with significant therapeutic potential in a range of diseases. Through the precise targeting of these proteins, Lexicon is pioneering the discovery and development of innovative medicines to treat disease safely and effectively. Lexicon has commercially launched one of these medicines, INPEFA^® (sotagliflozin) in the United States, and has a pipeline of other promising drug candidates in discovery and clinical and preclinical development in neuropathic pain, diabetes and metabolism and other indications. For additional information, please visit www.lexpharma.com.

Safe Harbor Statement

This press release contains “forward-looking statements,” including statements relating to Lexicon’s financial position and long-term outlook on its business, growth and future operating results, discovery, development and commercialization of products, strategic alliances and intellectual property, as well as other matters that are not historical facts or information. All forward-looking statements are based on management’s current assumptions and expectations and involve risks, uncertainties and other important factors, specifically including Lexicon’s ability to meet its capital requirements, successfully commercialize INPEFA in heart failure, conduct preclinical and clinical development and obtain necessary regulatory approvals of sotagliflozin (in other indications), LX9211, LX9851 and its other drug candidates on its anticipated timelines, achieve its operational objectives, obtain patent protection for its discoveries and establish strategic alliances, as well as additional factors relating to manufacturing, intellectual property rights, and the therapeutic or commercial value of its products and drug candidates. Any of these risks, uncertainties and other factors may cause Lexicon’s actual results to be materially different from any future results expressed or implied by such forward-looking statements. Information identifying such important factors is contained under “Risk Factors” in Lexicon’s annual report on Form 10-K for the year ended December 31, 2023 and other subsequent disclosure documents filed with the Securities and Exchange Commission. Lexicon undertakes no obligation to update or revise any such forward-looking statements, whether as a result of new information, future events or otherwise.

For Investor Inquiries:
Lisa DeFrancesco
Lexicon Pharmaceuticals, Inc.
lexinvest@lexpharma.com 

For Media Inquiries:
Alina Cocuzza
Lexicon Pharmaceuticals, Inc.
acocuzza@lexpharma.com

FAQ

What is INPEFA (sotagliflozin) and how does it work?

INPEFA is a dual oral inhibitor of SGLT2 and SGLT1 used to reduce the risk of heart failure events in HFpEF patients.

What were the key findings of the INPEFA Phase 3 post-hoc analysis?

The analysis showed that INPEFA significantly reduced heart failure events, especially in patients with obesity-related HFpEF.

Which clinical trials were included in the INPEFA post-hoc analysis?

The SOLOIST-WHF and SCORED trials, involving a total of 1,932 patients, were included.

What are the potential risks associated with INPEFA?

Risks include ketoacidosis, volume depletion, urinary tract infections, genital mycotic infections, and drug interactions.

How does BMI affect INPEFA's effectiveness?

Patients with a BMI ≥ 30 kg/m² showed a greater reduction in heart failure events when treated with INPEFA.

Is INPEFA recommended for use during pregnancy?

No, INPEFA is not recommended during the second and third trimesters of pregnancy or while breastfeeding.

Are there any special considerations for elderly patients using INPEFA?

Elderly patients may have an increased risk of volume depletion adverse reactions, including hypotension.

What should be monitored when using INPEFA?

Renal function, volume status, signs of urinary tract infections, and symptoms of ketoacidosis should be monitored.