icodec insulin, which will be sold under the Awiqli brand, is the first once-weekly basal insulin injection and will be available nationwide starting June 30, according to the company.
Canada is the first country to obtain this product, which was approved by Health Canada in March for the treatment of adults with type 1 and type 2 diabetes.
“I think it’s a very big deal,” said Dr. Harpreet Bajaj, head of the clinical practice guidelines steering committee at Diabetes Canada.
“(It’s) huge in reducing the burden on these people who have to inject insulin,” added Dr. Bajaj, an endocrinologist at the LMC clinic, which specializes in diabetes and endocrinology and is funded by the State and located in southern Ontario and Calgary.
He said some of his patients participated in clinical trials of Awiqli and asked when it would be available because they had to return to daily injections since the study ended.
Especially for type 2 diabetes
Although weekly insulin is approved by Health Canada for the treatment of type 1 and type 2 diabetes, endocrinologists say it will be most useful for type 2 patients.
This is largely because patients with type 1 diabetes would have to give themselves extra injections of fast-acting insulin every day at mealtimes, because their bodies do not produce insulin on their own. -same, explained Dr. Bajaj.
People with type 2 diabetes produce insulin, but in some cases they don’t generate enough, and in others their bodies don’t use it properly. Basal insulin injections bring their hormone levels to the right level during fasting, and other medications can control the “sugar spikes that come with food,” Dr. Bajaj said.
The series of randomized clinical trials for Awiqli – which included many countries, including Canada and the United States – were primarily conducted in type 2 patients. Only one of the trials involved patients with type 2 diabetes. 1; it found a higher risk of hypoglycemia when these patients took the weekly insulin option.
The United States Food and Drug Administration has not approved Awiqli. Its Endocrinology and Metabolic Drugs Advisory Committee concluded in May that more information was needed on the use of weekly insulin in type 1 diabetes patients.
Better adherence to treatment?
Dr. Alexander Abitbol, who is also an endocrinologist at LMC, said one of the main advantages of the new product is that more patients who need insulin will likely take it if it’s only once a week, which which will help protect them from devastating complications in cases where the disease is not properly treated.
“The impact for patients is that fewer of them will stay with high blood sugar levels for a long time,” said Dr. Abitbol.
“High blood sugar for too long contributes to eye disease, kidney disease, nerve disease, heart disease and all the other problems we hear about about diabetes.”
Awiqli works as a sustained release of insulin over the course of a week, Dr. Abitbol said.
The proteins in insulin are absorbed when injected and then bind to another protein in the blood called albumin, he said. With the weekly version, they bind more tightly, then the insulin proteins gradually break off.
The doctor, who was an investigator in the clinical trial involving type 1 diabetic patients, said he would mainly prescribe Awiqli to type 2 patients.
“I think that while weekly insulin is a fantastic tool for clinicians, we’re going to have to use it correctly,” he said.
“This will not be suitable for all diabetic patients, but for those who are suitable, it will likely be a better option than daily basal insulin.”
However, Awiqli may be the best option for some type 1 diabetic patients, Dr. Abitbol added, because it is the most convenient way for them to get the treatment they need.
“The type 1 (patient) who refuses to take his insulin is constantly in the hospital. Type 1 who might have a developmental or cognitive disorder, whose family helps him (to take insulin) and who may not be able to help him every day, might be able to do it once a week,” he explained.
An expensive product
Dr. Ehud Ur, a Vancouver endocrinologist who was not involved in the clinical trials, believes the new weekly insulin is “another tool in the toolbox” for treating diabetes — but that many patients might not get it. have access due to cost.
“This can be a good option because it gives you one needle per week rather than one needle every day,” the doctor said in an interview.
“The problem is that this is offset by a huge difference in price,” he said, pointing out that daily insulin injections – which have been around for a long time – are cheaper than a new insulin product patented.
The Canadian Medicines Agency, which evaluates drugs and recommends whether they should be reimbursed by public drug insurance plans, estimates that the cost of Awiqli will be more than $1,350 per year per patient.
The agency recommends on its website that Awiqli be funded for the treatment of type 2 diabetes, but on the condition that the price be reduced to match the least expensive of the most frequent insulin injections.
It is not yet clear whether private insurers will cover the more expensive weekly injection option for patients who prefer it, but Novo Nordisk is optimistic.
“We are seeing early positive signals that private drug plans are seeing the value that Awiqli brings to patients living with type 1 and type 2 diabetes,” spokesperson Kate Hanna said in an email. .
