New Secondary Analysis of Phase 3 Data Demonstrates that INPEFA® (Sotagliflozin) Benefited Heart Failure Patients Regardless of Diabetes Duration

Rhea-AI Summary

Lexicon Pharmaceuticals (Nasdaq: LXRX) announced new secondary analysis results from the Phase 3 SCORED trial for INPEFA® (sotagliflozin). The study showed that INPEFA reduced the risk of major adverse cardiovascular events (MACE) and heart failure (HF) events across all diabetes durations, with greater benefits for HF patients with longer diabetes duration.

Key findings include:

• INPEFA reduced primary endpoint events (5.6 vs 7.5 per 100 patient-years; HR: 0.74)
• MACE reduction: 4.8 vs 6.3 events per 100 patient-years (HR: 0.77)
• Increasing HF event reduction benefit with longer diabetes duration
• Results presented at the European Society of Cardiology Congress 2024

This analysis further differentiates INPEFA among SGLT inhibitors, highlighting its efficacy in reducing cardiovascular risks for heart failure patients, particularly those with longer diabetes duration.

Positive

• INPEFA reduced the risk of MACE and HF events across all diabetes durations
• Greater HF event reduction benefit observed in patients with longer diabetes duration
• Primary endpoint events reduced by 26% (HR: 0.74) in INPEFA group vs placebo
• MACE reduced by 23% (HR: 0.77) in INPEFA group compared to placebo
• Results further differentiate INPEFA among SGLT inhibitors

Negative

• None.

Insights

Medical Research Analyst

This post-hoc analysis of the SCORED trial reveals significant insights into INPEFA's (sotagliflozin) efficacy across different diabetes durations. The study demonstrates that INPEFA reduces the risk of major adverse cardiovascular events (MACE) and heart failure (HF) events across all diabetes duration subgroups. Notably, patients with longer diabetes duration showed greater benefits for HF event reduction.

Key findings include:

• Primary endpoint (CV death, HF hospitalization, urgent HF visit) reduced by 26% (HR: 0.74; 95% CI: 0.63, 0.88)
• MACE reduced by 23% (HR: 0.77; 95% CI: 0.65, 0.91)
• Increasing treatment benefit for HF events with longer diabetes duration

These results suggest INPEFA's potential as a valuable treatment option for HF patients, particularly those with longstanding diabetes, addressing a critical need in cardiovascular care.

Financial Analyst

The positive results from this secondary analysis of INPEFA (sotagliflozin) could have significant implications for Lexicon Pharmaceuticals (NASDAQ: LXRX). The data strengthens INPEFA's market position within the competitive SGLT inhibitor class by demonstrating efficacy across diabetes durations and potentially greater benefits for long-term diabetics.

Key financial considerations:

• Expanded market potential, particularly in the growing population of long-term diabetics with heart failure
• Potential for increased adoption by healthcare providers and payers due to demonstrated efficacy
• Differentiation from other SGLT2 inhibitors could lead to market share gains

While specific revenue projections aren't provided, these results could positively impact INPEFA's sales trajectory and Lexicon's financial outlook. Investors should monitor future sales data and market penetration rates to gauge the commercial impact of these findings.

Results showed reductions in heart attack, stroke and heart failure events in all patients with even greater benefit for heart failure events among patients with longer diabetes duration

New analysis further differentiates INPEFA among SGLT inhibitors

THE WOODLANDS, Texas, Sept. 03, 2024 (GLOBE NEWSWIRE) -- Lexicon Pharmaceuticals, Inc. (Nasdaq: LXRX) today announced that a post-hoc analysis of Phase 3 data from the SCORED clinical trial demonstrated that INPEFA® (sotagliflozin) reduced the risk of major adverse cardiovascular events (MACE) and heart failure (HF) events across the spectrum of diabetes duration. Researchers noted that HF patients with longer durations of diabetes derived greater benefit from INPEFA, even controlling for similar baseline HbA1c, yet all patients regardless of diabetes duration benefited from the therapy. These findings were presented August 30^th at the European Society of Cardiology (ESC) Congress 2024 in London, United Kingdom and online.

Diabetes duration is a well-established significant risk factor for cardiovascular (CV) disease and its progression. People with longer diabetes duration have a higher CV disease risk. The objective of this analysis of SCORED, one of two pivotal studies that led to FDA approval of INPEFA for heart failure in May 2023, was to evaluate if diabetes duration modifies the efficacy of INPEFA. The primary endpoint was a composite of CV death, HF hospitalization, and urgent heart failure visit events. Secondary endpoints included MACE: CV death, nonfatal heart attack and nonfatal stroke.

Study results showed treatment with INPEFA reduced risk of MACE and HF events overall, plus an increasing benefit for HF event reduction for patients with longer diabetes duration. In SCORED, 10,579 (99.9%) of 10,584 patients had complete data on diabetes duration, with 2412 (22.8%), 4424 (41.8%), 3743 (25.9%) having diabetes duration of <10, 10-19, and ≥20 years respectively. Median (Q1, Q3) diabetes duration was 16.4 years (10.4, 22.4 years), while mean hemoglobin A1c was 8.6%, 8.7%, and 8.7% respectively by diabetes duration.

The rate of the primary endpoint was lower in the INPEFA group (5.6 events per 100 patient-years [p-y]) compared with the placebo group (7.5 events per 100 p-y) (HR: 0.74; 95% CI: 0.63, 0.88). Event rates among diabetes duration subgroups indicated that rates in both the placebo group and relative treatment benefit increased with increasing diabetes duration, with 5.6 vs 5.8 events per 100 p-y, 6.1 vs 7.4 events per 100 p-y, and 4.6 vs 8.5 events per 100 p-y for diabetes duration <10, 10-19, and ≥20 years respectively. Spline analysis indicated increasing treatment benefit with increasing duration when modeled continuously.

Similar findings were observed for the secondary HF outcome of hospitalization for HF or urgent visit for HF, with increased treatment benefit with increasing diabetes duration. Total MACE was lower in the INPEFA group (4.8 events per 100 patient-years) than in the placebo group (6.3 events per 100 patient-years) (HR: 0.77; 95% CI: 0.65, 0.91), without significant difference in relative treatment benefit by diabetes duration.

“This analysis reinforces clinical data previously shared with the medical community showing that treatment with INPEFA resulted in risk reductions for both heart failure and MACE events in heart failure patients,” said Craig Granowitz, M.D., Ph.D., Lexicon’s senior vice president and chief medical officer. “These benefits are critically important for patients, clinicians, and payers, and they are key differentiators within the class of SGLT2 inhibitors.”

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, including the commercialization of its approved products and the clinical development of, regulatory filings for, and potential therapeutic and commercial potential of its other drug candidates. In addition, this press release also contains forward looking statements relating to Lexicon’s 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 its approved products, successfully conduct preclinical and clinical development and obtain necessary regulatory approvals of 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 approved products and other 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, as 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 and Media Inquiries:
Lisa DeFrancesco
Lexicon Pharmaceuticals, Inc.
lexinvest@lexpharma.com

FAQ

What were the key findings of the INPEFA Phase 3 SCORED trial secondary analysis?

The analysis showed that INPEFA reduced the risk of major adverse cardiovascular events (MACE) and heart failure (HF) events across all diabetes durations. Patients with longer diabetes duration experienced greater benefits for HF event reduction. The primary endpoint events were reduced by 26% in the INPEFA group compared to placebo.

How did INPEFA (sotagliflozin) perform in reducing MACE in the SCORED trial?

INPEFA demonstrated a 23% reduction in total MACE (major adverse cardiovascular events) compared to placebo. The INPEFA group experienced 4.8 events per 100 patient-years, while the placebo group had 6.3 events per 100 patient-years (HR: 0.77; 95% CI: 0.65, 0.91).

What impact does diabetes duration have on INPEFA's efficacy for heart failure patients?

The study found that heart failure patients with longer durations of diabetes derived greater benefit from INPEFA, even when controlling for similar baseline HbA1c. However, all patients, regardless of diabetes duration, benefited from the therapy in terms of reduced cardiovascular and heart failure events.

When and where were the results of the INPEFA SCORED trial analysis presented?

The results of the INPEFA SCORED trial secondary analysis were presented on August 30th at the European Society of Cardiology (ESC) Congress 2024 in London, United Kingdom and online.