FDA approves Ozempic for cardiovascular risk reduction in adults with type 2 diabetes and known heart disease, updates Rybelsus label
[caption id="attachment_9277" align="aligncenter" width="747"] Press Release[/caption]
PLAINSBORO, N.J.,?Jan. 16, 2020?/PRNewswire/?--?Novo Nordisk today announced that the U.S. Food and Drug Administration (FDA) has approved a new indication for Ozempic??(semaglutide) injection 0.5 mg or 1 mg to reduce the risk of major adverse cardiovascular events (MACE) such as heart attack, stroke, or death in adults with type 2 diabetes and known heart disease.1?Additional details were added to the Rybelsus??(semaglutide) tablets 7 mg or 14 mg Prescribing Information about the primary analysis for PIONEER 6.
Cardiovascular disease (CVD) is the main cause of death and disability among people with type 2 diabetes.2?Adults with type 2 diabetes are two to four times more likely to develop CVD than adults without diabetes.3
The FDA's decision on Ozempic??is based on results from the SUSTAIN 6 cardiovascular outcomes trial (CVOT) which examined the cardiovascular safety of adding Ozempic??or placebo to standard of care in adults with type 2 diabetes and established cardiovascular disease. In the 2-year SUSTAIN 6 trial, Ozempic??significantly reduced the risk of the occurrence of a three-component MACE endpoint consisting of cardiovascular death, non-fatal heart attack or non-fatal stroke. The estimated relative risk reduction of MACE was 26% vs placebo (HR 0.74 [95% CI: 0.58, 0.95], p<0.001 for noninferiority, median observation time 2.1 years) with the primary composite outcome occurring in 6.6% of patients treated with Ozempic??vs 8.9% with placebo.1,4?During the trial, gastrointestinal adverse events were more frequent in the Ozempic??group than in the placebo group. The majority of gastrointestinal adverse?events occurred during the first 30 weeks.4
"There is a well-established link between cardiovascular disease and type 2 diabetes. It's one of our biggest concerns with type 2 diabetes because even when patients reach their blood sugar targets, the risk of a major adverse CV event remains," said?Todd Hobbs, vice president and U.S. chief medical officer of Novo Nordisk. "Today's milestone establishes Ozempic??as an option for patients to help address two critical aspects of managing type 2 diabetes, blood sugar control and cardiovascular risk reduction, in those with known heart disease."
The Rybelsus??prescribing information has been updated in section 14 (clinical studies) to include an analysis from the primary endpoint of the PIONEER 6 CVOT showing the hazard ratio for time to first three-component MACE (HR 0.79 [95% CI: 0.57, 1.11]).5
In?June 2019, Novo Nordisk initiated the SOUL CVOT in 9,642 adults with type 2 diabetes and established cardiovascular disease to further evaluate the cardiovascular effect?of Rybelsus?. The trial is investigating the effects of Rybelsus??on the incidence of MACE vs placebo in addition to standard of care.
About the SUSTAIN 6 Trial
SUSTAIN 6 was an event- and time-driven, pre-approval CVOT for Ozempic?. It was a randomized, double-blinded, noninferiority placebo-controlled trial evaluating the cardiovascular safety of Ozempic??vs placebo when added to standard of care in 3,297 adults with type 2 diabetes with established CVD for a minimum observation period of two years.
About Ozempic?
Ozempic??(semaglutide) injection 0.5 mg or 1 mg is a once-weekly glucagon-like peptide-1 (GLP-1) receptor agonist indicated along with diet and exercise to improve blood sugar (glucose) in adults with type 2 diabetes mellitus and to reduce the risk of major cardiovascular events such as heart attack, stroke or death in adults with type 2 diabetes mellitus with known heart disease. Ozempic??was approved by the U.S. Food and Drug Administration on?December 5, 2017, by Health Canada on?January 4, 2018, by the European Commission on?February 9, 2018, by the Japanese Ministry of Health, Labour and Welfare on?March 23, 2018, by Swissmedic on?July 2, 2018, and by the Brazilian National Health Surveillance Agency on?August 6, 2018.
What is?Ozempic??
Ozempic??(semaglutide) injection 0.5 mg or 1 mg is an injectable prescription medicine?used:
- along with diet and exercise to improve blood sugar (glucose) in adults with type 2 diabetes mellitus.
- to reduce the risk of major cardiovascular events such as heart attack, stroke or death in adults with type 2 diabetes mellitus with known heart disease.
- Possible thyroid tumors, including cancer.?Tell your health care provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, Ozempic??and medicines that work like Ozempic??caused thyroid tumors, including thyroid cancer. It is not known if Ozempic??will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people.
- Do not use Ozempic??if you or any of your family have ever had MTC, or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
- you or any of your family have ever had MTC or if you have MEN 2.
- you are allergic to semaglutide or any of the ingredients in Ozempic?.
- have or have had problems with your pancreas or kidneys.
- have a history of diabetic retinopathy.
- are pregnant or breastfeeding or plan to become pregnant or breastfeed. It is not known if Ozempic??will harm your unborn baby or passes into your breast milk. You should stop using Ozempic??2 months before you plan to become pregnant.
- inflammation of your pancreas (pancreatitis).?Stop using Ozempic??and call your health care provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back.
- changes in vision.?Tell your health care provider if you have changes in vision during treatment with Ozempic?.
- low blood sugar (hypoglycemia).?Your risk for getting low blood sugar may be higher if you use Ozempic?with another medicine that can cause low blood sugar, such as a sulfonylurea or insulin.?Signs and symptoms of low blood sugar may include:?dizziness or lightheadedness, blurred vision, anxiety, irritability or mood changes, sweating, slurred speech, hunger, confusion or drowsiness, shakiness, weakness, headache, fast heartbeat, and feeling jittery.
- kidney problems (kidney failure).?In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems to get worse. It is important for you to drink fluids to help reduce your chance of dehydration.
- serious allergic reactions.?Stop using Ozempic??and get medical help right away if you have any symptoms of a serious allergic reaction, including itching, rash, or difficulty breathing.
- Rybelsus??is not recommended as the first choice of medicine for treating diabetes
- It is not known if Rybelsus??can be used in people who have had pancreatitis
- Rybelsus??is not for use in people with type 1 diabetes and people with diabetic ketoacidosis
- It is not known if Rybelsus??is safe and effective for use in children under 18 years of age
- Possible thyroid tumors, including cancer.?Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In studies with rodents, Rybelsus??and medicines that work like Rybelsus??caused thyroid tumors, including thyroid cancer. It is not known if Rybelsus??will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people
- you or any of your family have ever had MTC, or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
- you are allergic to semaglutide or any of the ingredients in Rybelsus?
- have or have had problems with your pancreas or kidneys
- have a history of vision problems related to your diabetes
- are pregnant or plan to become pregnant. It is not known if Rybelsus??will harm your unborn baby. You should stop using Rybelsus??2 months before you plan to become pregnant. Talk to your healthcare provider about the best way to control your blood sugar if you plan to become pregnant or while you are pregnant
- are breastfeeding or plan to breastfeed. Breastfeeding is not recommended during treatment with Rybelsus?
- Take Rybelsus??exactly as your healthcare provider tells you to
- Take Rybelsus??by mouth on an empty stomach when you first wake up with a sip of plain water (no more than 4 ounces)
- Do not split, crush, or chew. Swallow Rybelsus??whole
- After 30 minutes, you can eat, drink, or take other oral medications. Rybelsus??works best if you eat 30 to 60 minutes after taking it
- If you miss a dose of Rybelsus?, skip the missed dose and go back to your regular schedule
- inflammation of your pancreas (pancreatitis).?Stop using Rybelsus??and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back
- changes in vision.?Tell your healthcare provider if you have changes in vision during treatment with Rybelsus?
- low blood sugar (hypoglycemia).?Your risk for getting low blood sugar may be higher if you use Rybelsus?with another medicine that can cause low blood sugar, such as a sulfonylurea or insulin.?Signs and symptoms of low blood sugar may include:?dizziness or lightheadedness, blurred vision, anxiety, irritability or mood changes, sweating, slurred speech, hunger, confusion or drowsiness, shakiness, weakness, headache, fast heartbeat, and feeling jittery
- kidney problems (kidney failure).?In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems to get worse. It is important for you to drink fluids to help reduce your chance of dehydration
- serious allergic reactions.?Stop using Rybelsus??and get medical help right away, if you have any symptoms of a serious allergic reaction including itching, rash, or difficulty breathing
- Ozempic??[package insert].?Plainsboro, NJ: Novo Nordisk Inc;?January 2020.
- Low Wang CC, Hess CN, Hiatt WR, Goldfine AB. Clinical Update: Cardiovascular disease in diabetes mellitus: Atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus - mechanisms, Management, and Clinical Considerations.?Circulation. 2016;133(24):2459-2502.
- World Heart Federation. Cardiovascular disease risk factors. Available at:?www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/diabetes/. Accessed?January 9, 2020.
- Marso SP, Bain SC, Consoli A, et al; SUSTAIN-6 Investigators. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes.?N Engl J Med.?2016:375:1834-1844.
- Rybelsus??[package insert].?Plainsboro, NJ: Novo Nordisk Inc;?January 2020.