Victoza is still the champ in the A1c battle, at least….

 

GSK announced today results of their albiglutide trial against Novo Nordisk’s Victoza (liraglutide).  And once again, Victoza (QD dosing) was called into the ring to take on a QW dosing GLP-1 and has come out victorious.  In this case, Albi lowered HbA1c 0.78% compared to 0.99% for lira.

This is the second time that a QW GLP-1 manufacturer has attempted a non-inferiority trial against liraglutide.  You might remember a few months ago, Lilly and Amylin announced a similar result for exenatide once-weekly against liraglutide, -1.28% compared to -1.48%.

One thing jumps out in both trials, is the consistency in rates of nausea, both the once weekly versions had roughly 9%, compared to the 20% and 29% reported for liraglutide.  It is always VERY dangerous to compare different studies, particularly when the HbA1c impact was markedly different, indicating considerably different baseline characteristics.

Is it too early to conclude something physiologically about GLP-1?  In essence, is there a reason the body releases GLP-1 when food is ingested, resulting in the glucose dependent insulin response seen in a non-diabetic state?  Is there something else going on in the body?  Good questions for the academics to figure out on rats.

In here the real world, will the potential for modestly lower HbA1c difference in the QWs be offset by the reduced nausea that has plagued the class?  Or will the once weekly administration be the trump card, even if the once weekly is offered a large gauge needle for administration?  Or are the results seen in the QWs to date the best we will see and be prepared for an even further fall from grace?

Secondly, what does this mean for companies like Intarcia, developing a micro-implant for GLP-1 administration?

Lastly, is there actually room for everyone in the space, and there won’t be any real “champ”, but much like professional boxing, a hodgepodge of manufacturers claiming their own spin on superiority, and secretly, Don King is behind it all for the pay-per-view ratings?

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