Farxiga could tie a fourth string to its bow

Astrazeneca’s SGLT2 inhibitor Farxiga is already marketed for types 1 and 2 diabetes, and looks set to be approved for heart failure, but today brought news of a possible fourth indication. The drug’s Dapa-CKD trial, in chronic kidney disease (CKD), has been halted for “overwhelming efficacy”. Perhaps the most important aspect of Dapa-CKD is that it recruited diabetics and non-diabetics alike; use in the latter population could allow Astra to overtake Johnson & Johnson’s SGLT2 rival, Invokana, which is already approved to treat CKD, but only in type 2 diabetics. Of course, without knowing the full data the extent to which diabetics drove the overall Dapa-CKD result is not clear, so scrutinising the full dataset should focus on the benefit in non-diabetics. Assuming that Farxiga has shown a strong result in this subgroup a vital consideration is the role of Lilly/Boehringer Ingelheim’s rival Jardiance. That drug’s CKD study, Empa-Kidney, also recruits all-comers, and reads out in 2022. Astra’s bull case is that Farxiga now has a two-year window in which to make headway.