Chris Sorli, MD: Renal Function on Toujeo versus Tresiba

A recent analysis of the BRIGHT trial has found that insulin glargine 300u/mL (Gla-300), also known as Toujeo, appears to have advantages for patients with impaired renal function compared to insulin degludec 100U/mL (IDeg), also known as Tresiba.

Investigators presented results of the analysis, which examined HbA1c change and confirmed hypoglycemia, was presented at the American Diabetes Association 2019 Scientific Sessions in San Francisco, CA. After analysis, investigators found lower confirmed hypoglycemia rates with Gla-300 compared with IDeg in those with normal renal function, with comparable HbA1c reduction.

Chris Sorli, MD, vice president of medical affairs at Sanofi, sat down with MD Magazine® at ADA 2019 to discuss the results of the analysis.

MD Mag: What were the findings of this analysis of the BRIGHT trial?

Sorli: So, the BRIGHT trial is a comparative study between Toujeo and Tresiba. The way it was performed was a randomized, controlled, open-label trial looking at the new basal insulin Tresiba and Toujeo. In basal insulins that have flatter durations of action, longer profiles and it's really to try to figure out how we're implementing these into clinical practice and how we get the best in terms of individualized patient care. So, in this head-to-head trial, which is the first randomized head-to-head trial between the two, the initial results were published last year.

They essentially demonstrated that both of the basal insulins are highly effective at lowering glucose, controlling a1c, and have quite low rates of hypoglycemia. What we're looking at this year and we had pre-specified these sub analyses. Are there patient populations within the BRIGHT trial that have clinical relevance, in terms of management of individual patients? The answer is absolutely yes.

One of which are individuals with renal insufficiency. So, we predefined an analysis looking at levels of renal insufficiency in a comparative analysis between Tresiba and Toujeo — separating by glomerular filtration rate. So, based off your kidney function what were the outcomes of the trial and what we're reporting this year is that in individuals in the trial who had reduced GFRs or reduced levels of moderate to severe kidney impairment, a GFR specifically less than 60, were actually able to demonstrate a difference with greater reduction in a1c for Toujeo versus Tresiba over the treatment period of 26 weeks and that was without any increase or payback in terms of hypoglycemic risk actually.

So, it's an interesting analysis and what's the clinical relevance of that? It remains to be determined. We actually think, given that this was a pre-specified sub analysis, it's an interesting finding that we're excited about and we want to explore that further. So, we plan to look into that in more detail in the future.