Company announcement
No. 38 / 2023
9
diabetes (eligible HbA1c <6.5%) and SYNCHRONIZE
TM
-2 will
enroll people with type 2 diabetes (eligible HbA1c ≥6.5%
<10%).
For both trials, the primary endpoints are percentage
change in body weight at week 76 and the proportion of
people who achieve body weight loss of 5% or more at week
76. A total of 600 participants will be enrolled in each of the
two trials, randomized to receive weekly subcutaneous
injections of either survodutide, reaching a maximum dose
of 3.6 mg or 6.0 mg for maintenance treatment, or placebo.
SYNCHRONIZE
TM
-CVOT (ClinicalTrials.gov ID:
NCT06077864) is a Phase 3 trial that will enroll people with
overweight or obesity with cardiovascular disease, chronic
kidney disease, or risk factors for cardiovascular disease. In
SYNCHRONIZE
TM
-CVOT, the primary endpoint is the time to
first occurrence of any one of five major adverse cardiac
events (5P-MACE): cardiovascular death, non-fatal stroke,
non-fatal myocardial infarction, ischemia-related coronary
revascularization and heart failure events.
A Phase 2 randomized, placebo-controlled, double-blind,
trial evaluated survodutide compared to placebo in people
with overweight or obesity (ClinicalTrials.gov ID:
NCT04667377). Participants received multiple rising doses
of survodutide in one of four dose groups or placebo and
included 20 weeks of dose escalation and 26 weeks of
maintenance. Based on the planned maintenance dose
assigned at randomization regardless of whether the
planned dose was reached during the dose escalation
phase, survodutide achieved up to 14.9% mean weight loss
from baseline after 46 weeks. An analysis based on the
actual maintenance dose regardless of assignment at
randomization, showed up to 18.7% mean weight loss after
46 weeks. Bodyweight reductions with survodutide had not
reached a plateau at week 46, suggesting additional weight
loss could be achieved with longer treatment duration. Up
to 40% of people who reached the highest two doses of
survodutide, 3.6 mg and 4.8 mg, achieved a weight loss of
at least 20%.
Serious adverse events were reported by 4.2% of participants
on survodutide versus 6.5% of those on placebo. Treatment
discontinuation due to adverse events occurred in 24.6%
and 3.9% of participants on survodutide and placebo,
respectively, mainly due to gastrointestinal adverse events.
Most treatment discontinuations due to adverse events
occurred during the rapid 20-week dose-escalation phase
with up-titration every second week. Thus, the safety and
tolerability profile of survodutide was in line with other
incretin-based pharmacotherapies. The treatment
discontinuation rate of survodutide was also roughly similar
to the treatment discontinuation rates seen with other
incretin-based pharmacotherapies in previous Phase 2 trials
in type 2 diabetes and obesity. Boehringer Ingelheim and
Zealand Pharma expect that treatment discontinuations due
to adverse events can be mitigated with more gradual dose
escalation over a longer duration in Phase 3. The detailed
results from the Phase 2 trial were presented at the ADA 83
rd
Scientific Sessions in June 2023.
A Phase 2 randomized, placebo-controlled, double-blind
trial evaluated survodutide in people with type 2 diabetes on
stable metformin background therapy (ClinicalTrials.gov ID:
NCT04153929). Participants received multiple rising doses
of survodutide in one of six dose groups, placebo or open-
label weekly semaglutide 1.0 mg for 16 weeks. Treatment
with survodutide led to dose-dependent decreases in
HbA1c, with mean reductions of -0.93% to -1.88% at 16
weeks across the six dose groups, compared with -0.25%
seen with placebo. Treatment with open-label weekly
semaglutide at 1.0 mg led to a decrease in HbA1c of -1.47%.
Boehringer Ingelheim presented these results at the 58th
Annual Meeting of the European Association for the Study
of Diabetes (EASD) in September 2022.
A third Phase 2 trial is assessing survodutide in non-alcoholic
steatohepatitis (NASH) and liver fibrosis stages F1/F2/F3
(ClinicalTrials.gov ID: NCT04771273). The NASH program
has received Fast Track Designation from the US FDA. In
people living with overweight and obesity, it is estimated that
75% have nonalcoholic fatty liver disease (NAFLD) and 34%
have NASH. Boehringer Ingelheim and Zealand expect to
report topline results from the Phase 2 trial with survodutide
in NASH in the first half of 2024.
Survodutide was co-invented by Boehringer Ingelheim and
Zealand. Boehringer Ingelheim is funding all research,
development and commercialization activities related to
survodutide. Zealand is eligible to receive up to EUR 345
million in outstanding milestone payments, including the
EUR 30 million recognized in the third quarter of 2023, and
high-single to low-double digit royalties on global sales.
Type 1 Diabetes Management
Dasiglucagon for Bihormonal Artificial Pancreas systems
Background:
Zealand is developing a pre-filled dasiglucagon cartridge
intended for use in Bihormonal Artificial Pancreas systems,
which hold potential to improve the management of type 1
diabetes (T1D). Zealand is collaborating with Beta Bionics,
developer of the Bihormonal iLet® Bionic Pancreas (iLet
Duo™), a pocket-sized, dual chamber (insulin and
glucagon), autonomous, glycemic control system. The iLet
Duo™ is an investigational device, limited by federal (or
United States) law to investigational use only. The iLet®
Bionic Pancreas platform is designed to use adaptive, self-
learning, control algorithms, together with continuous
glucose monitoring and pump technology, to
autonomously compute and administer doses of insulin
and/or glucagon and mimic the body’s natural ability to
maintain tight glycemic control.