Switching to Insulin Glargine Plus Lixisenatide from GLP-1RA

A recent study has found that switching to titratable fixed-ratio combination of insulin glargine plus lixisenatide can improve glucose control for type 2 diabetes patients receiving the maximum tolerated GLP-1RA dose with oral antidiabetics.

Investigators sought to determine the ability of insulin glargine plus lixisenatide in a 26-week randomized, open-label trial that compared switching to the treatment versus continuing a maximally tolerated dose of GLP-1RA.

After examining 514 patients, which were randomized 1:1 to receive insulin glargine plus lixisenatide or GLP-1RA, investigators found that insulin glargine plus lixisenatide provided greater HbA1c reductions than GLP-1RA — from 7.8% at baseline to 6.7% and 7.4%, respectively. Additionally, the GLP-1RA group had less patients achieve HbA1c targets.

Christopher Sorli, MD, vice president of medical affairs at Sanofi, recently sat down with MD Magazine® to discuss the results of the trial and their clinical implications.

MD Mag: What were the results of the LixiLan-G trial?

Sorli: So, LixiLan-G, just to clarify LixiLan refers to our product Soliqua which is now on the market, but LixiLan-G is one of the phase 3 trials that was performed to give us some information about how Soliqua in the marketplace and what are the right patient populations.

In this particular trial, it's a randomized trial taking individuals who have previously been treated with oral agents plus a GLP-1.So, these are individuals who are not at goal, who are actually on GLP-1 therapy plus oral agents and now you randomize to ongoing treatment with their current GLP-1 therapy or randomization to Soliqua, which is a fixed ratio combination of a short-acting GLP-1 lixisenatide with a basal insulin glargine and what the study shows is after the 26 week treatment period is a significant improvement in glycaemia for those individuals treated with Soliqua.

So, a better effect, better a1c reduction, more patients achieving a goal of less than 7 on the fixed-ratio combination Soliqua. So, this is kind of an interesting trial in terms of relevance to clinical practice. We are obviously very interested in where the future of incretin therapies are and this study starts to tell us in an individual who is not at goal on a GLP-1, is a fixed-ratio combination like Soliqua a viable option? And the answer is absolutely yes, with great efficacy demonstrated in the LixiLan-G trial.