Diabetes Medicine, Dapagliflozin also Shows unprecedented benefits in Patients with Chronic Kidney Disease

·       Global clinical study conducted by AstraZeneca, including study population from India, shows positive results for its anti-diabetic drug dapagliflozin in reducing chronic kidney disease (CKD) progression in patients with or without type 2 diabetes

·       AstraZeneca’s dapagliflozin is the first medicine in SGLT-2i class to move into a new disease area by demonstrating efficacy and safety data for the treatment of patients with CKD.

 

Bangalore, India: AstraZeneca India (AstraZeneca Pharma India Limited), a leading science-led biopharmaceutical company, today announced the full results from the clinical trials of it’s  latest diabetes drug, dapagliflozin, showing significant benefits in reducing chronic kidney disease (CKD) progression in patients with and without type-2 diabetes. The DAPA-CKD study concluded globally on 30th March 2020 based on its effectiveness and safety.1

 

Chronic kidney disease (CKD) is an emerging public health problem. Global disease burden report of 2015 pointed that is CKD is the 12th most common cause of death with a 37.1% rise in mortality over 10 years. It is a serious, progressive condition defined by decreased kidney function and/or kidney damage,2,3  affecting nearly 70 Crore people worldwide, many of them still undiagnosed.4,5  The prevalence of CKD in India is estimated to be 17.2%, given its population >1 billion, the rising incidence of CKD is likely to pose major problems for both healthcare and the economy in future years6. CKD is associated with significant patient death and an increased risk of cardiovascular (CV) events,7such as heart failure and premature death.8While there are medications that can address some of the risk factors for CKD or its associated problems, few work directly to slow renal disease progression.9,10

 

Detailed results from the ground-breaking Phase III DAPA-CKD trial showed that AstraZeneca’s  dapagliflozin on top of standard of care reduced the composite measure of worsening of renal function or risk of cardiovascular (CV) or renal death by 39% compared to placebo (p<0.0001) in patients with chronic kidney disease (CKD) Stages 2-4 and elevated urinary albumin excretion. The results were consistent in patients both with and without type-2 diabetes (T2D). CKD is a serious, progressive condition defined by decreased kidney function affecting nearly 700 million people worldwide,11,12 many of them still undiagnosed,13,14 and the most common causes are diabetes, hypertension and glomerulonephritis.15

 

The primary composite endpoint was ≥50% sustained decline in estimated glomerular filtration rate (eGFR), onset of end-stage kidney disease (ESKD) and CV or renal death. The absolute risk reduction (ARR) was 5.3% over the median time in study of 2.4 years. The trial also met all secondary endpoints, including significantly reducing death from any cause by 31% (ARR = 2.1%, p=0.0035) compared to placebo.

 

DAPA-CKD is the first trial to demonstrate efficacy, including improvement on survival, in CKD patients both with and without Type2 Diabetes.16

 

Dr. Anil Kukreja, Vice President – Medical Affairs & Regulatory, AstraZeneca India said “AstraZeneca has always been on the forefront of innovative solution for non-communicable diseases. Despite currently available therapies, a significant unmet need for effective management of CKD continues to exist globally. The DAPA-CKD trial which included 4,304 patients with CKD into a global study, with 201 patients from India. Now Dapa -CKD results goes on show that Dapagliflozin,which is already effective in Type 2 Diabetes, select Heart Failure patients has demonstrated significant efficacy now even in Chronic Kidney Disease. Dapagliflozin is the first SGLT2 inhibitor to demonstrate such unprecedented efficacy in management of Chronic Kidney disease.”

 “

 

Dr. Dinesh Khullar, national lead investigator of Dapa-CKD in India, said  “SGLT2 inhibitors of which dapagliflozin is a type have proved to be a very exciting and impressive class of drugs in the expanding armamentarium for our fight against diabetes. DAPA-CKD trial has shown an overwhelming advantage of the drug in slowing down the rate of progression of kidney disease in both diabetics as well as non diabetic patients.” 

 

In July 2020Dapagliflozin was recently approved by USFDA as well as in India to reduce the risk of CV death and hospitalisation for heart failure (hHF) in adults with heart failure (NYHA class II-IV) with reduced ejection fraction (HFrEF) with and without T2D. Dapagliflozin is currently being assessed in patients with heart failure (HF) in the DELIVER (HF with preserved ejection fraction, HFpEF) and DETERMINE (HFrEF and HFpEF) trials, as well as in patients without T2D following an acute myocardial infarction (MI) or heart attack in the DAPA-MI trial – a first of its kind, indication-seeking registry-based randomised controlled trial.

 

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

 

Chronic Kidney Disease

 

CKD can be a serious, progressive condition defined by decreased kidney function (shown by reduced eGFR or markers of kidney damage, or both, for at least three months).17 The most common causes of CKD are diabetes, hypertension and glomerulonephritis.18 CKD is associated with significant patient morbidity and an increased risk of CV events,19 such as HF and premature death.20In its most severe form, known as ESKD, kidney damage and deterioration of kidney function have progressed to the stage where dialysis or kidney transplantation are required.21 The majority of patients with CKD will die from CV causes before reaching ESKD.22

 

About AstraZeneca Pharma India Limited

 

AstraZeneca is a global, science-led biopharmaceutical company that focuses on the discovery, development and commercialisation of prescription medicines, primarily for the treatment of diseases in three therapy areas - Oncology, Cardiovascular, Renal & Metabolism and Respiratory. AstraZeneca operates in over 100 countries and its innovative medicines are used by millions of patients worldwide.

 

AstraZeneca Pharma India Limited (AZPIL) was established in 1979 and is marking its 40th year of long-standing commitment to patients in India. It is headquartered at Bengaluru, Karnataka. AstraZeneca India has a workforce of over 1400 employees across the country committed to deliver great medicines to patients through innovative science and global excellence in development and commercialization. For more information, please visit: www.astrazeneca.com/india

 

References

 

1.        Farxiga is the first SGLT2 inhibitor to show meaningful benefit in patients with chronic kidney disease in a trial including both type-2 diabetics and non-diabetics. Accessed from: https://www.astrazeneca.com/media-centre/press-releases/2020/farxiga-phase-iii-dapa-ckd-trial-will-be-stopped-early-after-overwhelming-efficacy-in-patients-with-chronic-kidney-disease.html

2.        Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International Supplement 2013; (3):1–150.

3.        Kidney Reasearch UK. Stages of kidney disease [cited 11.03.19]. Available from: URL: https://www.kidneyresearchuk.org/health-information/stages-of-kidney-disease.

4.         National Kidney Foundation. Kidney Disease: The Basics [cited 07.08.20]. Available from: URL: https://www.kidney.org/news/newsroom/factsheets/KidneyDiseaseBasics.

5.        Hirst JA et al. Prevalence of chronic kidney disease in the community using data from OxRen: A UK population-based cohort study. Br J Gen Pract 2020; 70(693):e285-e293.

6.        .Singh et al. Epidemiology and risk factors of chronic kidney disease in India – results from the SEEK (Screening and Early Evaluation of Kidney Disease) studyBMC Nephrology 2013, 14:114

7.        Bikbov B et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet 2020; 395(10225):709–33.

8.        Segall L et al. Heart failure in patients with chronic kidney disease: A systematic integrative review. Biomed Res Int 2014; 2014:937398.

9.        Ward F et al. Drug therapies to delay the progression of chronic kidney disease. Clin Med (Lond) 2015; 15(6):550–7.

10.     National Health Service. Treatment: Chronic kidney disease; 2019 [cited 2020 May 19]. Available from: URL: https://www.nhs.uk/conditions/kidney-disease/treatment/.

11.     Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International Supplement 2013; (3):1–150.

 

12.      Bikbov B et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet 2020; 395(10225):709–33.

 

13.     Hirst JA et al. Prevalence of chronic kidney disease in the community using data from OxRen: A UK population-based cohort study. Br J Gen Pract 2020; 70(693):e285-e293.

 

14.      National Kidney Foundation. Kidney Disease: The Basics; 2020 [cited 2020 Jun 29]. Available from: URL: https://www.kidney.org/news/newsroom/factsheets/KidneyDiseaseBasics.

 

15.      National Kidney Foundation. Kidney Disease: Causes, 2017; [cited 2020 Jun 25]. Available from URL: https://www.kidney.org/atoz/content/kidneydiscauses

16.     U.S. National Institutes of Health. A study to evaluate the effect of dapagliflozin on renal outcomes and cardiovascular mortality in patients with chronic kidney disease (Dapa-CKD) [Identifier: NCT03036150] [cited 2018 Jul 12]. Available from: URL: https://clinicaltrials.gov/ct2/show/NCT03036150.

 

17.     National Kidney Foundation. Kidney Disease: Causes, 2017; [cited 2020 Mar 28]. Available from URL: https://www.kidney.org/atoz/content/kidneydiscauses.

18.     Bikbov, Boris, et al. “Global, Regional, and National Burden of Chronic Kidney Disease, 1990–2017: a Systematic Analysis for the Global Burden of Disease Study 2017.” The Lancet, vol. 395, no. 10225, 13 Feb. 2020, pp. 709–733., doi:10.1016/s0140-6736(20)30045-3.

19.     Segall L et al. Heart failure in patients with chronic kidney disease: A systematic integrative review. Biomed Res Int 2014; 2014:937398.

20.     Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2019; [cited 2020 Mar 27]. Available from URL: https://www.cdc.gov/kidneydisease/publications-resources/2019-national-facts.html.

21.     Thompson S, James M, Wiebe N, Hemmelgarn B, Manns B, Klarenbach S and Tonelli M. Cause of Death in Patients with Reduced Kidney Function. Journal of the American Society of Nephrology. 2015, 26 (10) 2504-2511; DOI: https://doi.org/10.1681/ASN.2014070714.