Lilly’s new diabetes project looks good, but not knockout

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Lilly has promised great things from its new diabetes project tirzepatide, and yesterday the first look at phase III data emerged. While no serious safety signals were present, efficacy was not as good as some had expected. On the crucial blood sugar control measure tirzepatide certainly looks like it can hold its own against Novo Nordisk’s GLP-1 agents, but many were hoping that the Lilly project would hit 2%, according to Bernstein. The analysts also noted that weight loss came in lower than expected. On tolerability, the titration schedule that Lilly developed to control GI issues looks to have worked, although the full data will be important here. Dropouts, which hit 21.5% in the high 15mg group, also need closer examination – Lilly claimed that most of these were not due to adverse events, citing the pandemic and work reasons, but why this disproportionately affected the high-dose group is unclear. Still, with no mention of cardiovascular safety events, these data certainly make tirzepatide look approvable, the caveat being that these are only the first results from a vast, ongoing programme (Tirzepatide’s time to shine for Lilly, February 4, 2020).

Cross-trial comparison of tirzepatide and Novo's GLP-1 agonists
Project Tirzepatide* Ozempic Rybelsus
Company Lilly Novo Nordisk Novo Nordisk
A1C reduction (%) 1.69-1.75 1.4-1.6 1.2-1.4
% of pts achieving A1c <7 78-85 70-73 69-77
Placebo-adjusted weight loss (kg) 5.3-6.8 2.6-3.5 0.9-2.3
Nausea (%) 12-18 16-20 11-20
*Treatment-regimen estimand. Sources: Lilly release on Surpass-1 data & product labels.

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