AstraZeneca uses Farxiga's versatility to guide pipeline work, exec says

With seven posters and nine presentations on Farxiga over the weekend at the European Society of Cardiology (ESC) scientific sessions in Amsterdam, AstraZeneca made it clear that it has lots to say about its SGLT2 inhibitor.

And why not? As Farxiga has added four indications over the last five years—on top of its initial 2014 approval for Type 2 diabetes—its spillover benefits have become apparent and yielded a better understanding of the interconnections between Type 2 diabetes, heart failure (HF) and chronic kidney disease (CKD).

Now, the company is applying these lessons as it advances its pipeline prospects, Mina Makar, senior vice president of global cardiovascular, renal and metabolism (CVRM) at AZ, said in a recent interview.

At the ESC conference, AZ presented late-breaking data from a pooled analysis of two trials that showed a marked increase in risks associated with cardiovascular outcomes in patients with declining kidney function.

The analysis focused on HF patients who were initiated into the two trials with estimated glomerular filtration rate (eGFR) levels over 25 but who had fallen below that figure. Levels of eGFR are a measure of healthy kidney functioning, and the results reinforced the connection between HF and CKD, AZ said.

“We wanted to see, can a medicine like Forxiga still help these patients? And the answer is yes,” Helen Yeh, AZ’s medical vice president of the CVRM group, said in the interview. “We still see the benefit in those renally very impaired patients. I think that’s a very good piece of data.”

AZ also investigated interconnections between HF and chronic obstructive pulmonary disease (COPD). A multi-database cohort study illustrated how a COPD flare-up increased cardiopulmonary risk.

Another noteworthy finding was a real-world study that showed many patients don't start on a HF treatment regimen immediately after a hospitalization. Guideline recommendations are often not sufficiently implemented because of the perceived risk of side effects or insufficient reimbursement.

“These are HF patients with reduced ejection fraction that showed—according to the guidelines beyond all four pillars—that it’s taking an average of 200 days to get there,” Yeh said. “That tells us what a job we’ve got to do collectively to be able to get the right medicines to patients.”

The interconnectivity between the heart and the kidney was the primary theme for AZ with Farxiga—as it demonstrated in several ESC presentations—and it is helping guide its pipeline search for new treatments, Makar said.

“The nine to 10 new entities that we intend to launch in the next few years—if you look across, the science and the mechanisms and the phase 3 programs—are really designed to go across multiple organs and multiple comorbidities,” Makar said. “That’s where the future is.”

Also providing intelligence on the links between the heart, liver, pancreas and the kidneys has been Eli Lilly and Boehringer Ingelheim’s rival SGLT2 inhibitor Jardiance. Together, the drugs generated $10.5 billion in sales last year, with Jardiance racking up a $6.1 billion haul.