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US FDA approves Basaglar, the first “follow-on” insulin glargine product to treat diabetes

Washington: The US Food and Drug Administration on Wednesday approved Basaglar (insulin glargine injection), a long-acting human insulin analogue to improve glycaemic control in adult and paediatric patients with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus.

According to the Centres for Disease Control and Prevention, approximately 21 million people in the United States have been diagnosed with diabetes. Over time, diabetes increases the risk of serious health complications, including heart disease, blindness, and nerve and kidney damage. Improvement in blood sugar control can reduce the risk of some of these long-term complications.

“Long-acting insulin products like insulin glargine play an important role in the treatment of types 1 and 2 diabetes mellitus, and today’s (Wednesday’s) approval is expected to expand the availability of treatment options for health care professionals and patients,” said Dr Jean-Marc Guettier, director of the Division of Metabolism and Endocrinology Products in the FDA’s Centre for Drug Evaluation and Research.

Basaglar is the first insulin product approved through an abbreviated approval pathway under the Federal Food, Drug, and Cosmetic Act. A 505(b)(2) application was submitted for Basaglar that relied, in part, on the FDA’s finding of safety and effectiveness for Lantus (insulin glargine injection) to support approval. The applicant demonstrated that Basaglar was sufficiently similar to Lantus to scientifically justify reliance, and also provided Basaglar-specific data to establish the drug’s safety and efficacy for its approved uses. The Basaglar-specific data included two clinical trials enrolling 534 and 744 patients with type 1 and 2 diabetes mellitus respectively.

Dosing of Basaglar should be individualized based on the patient’s needs. Basaglar is administered subcutaneously once daily at any time of day, but at the same time every day, according to the FDA.

Basaglar should not be used during episodes of hypoglycaemia (low blood sugar) or in patients with hypersensitivity to insulin glargine or one of its ingredients. Basaglar KwikPens must never be shared between patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens, warned the FDA.

The FDA further said that patients or caregivers should monitor blood glucose in all patients treated with insulin products. Insulin regimens should be modified cautiously and only under medical supervision. Basaglar may cause low blood sugar (hypoglycaemia), which can be life-threatening. Patients should be monitored more closely with changes to insulin dosage, co-administration of other glucose-lowering medications, meal pattern, physical activity and in patients with renal impairment or hepatic impairment or hypoglycaemia unawareness.

Severe, life-threatening, generalized allergic reactions, including anaphylaxis, or generalized skin reactions, angioedema, bronchospasm, hypotension and shock may occur with any insulin.

The most common adverse reactions associated with Basaglar in clinical trials were hypoglycaemia, allergic reactions, injection site reactions, pitting at the injection site (lipodystrophy), itching, rash, oedema (fluid retention) and weight gain.

Basaglar received tentative approval from the FDA on August 18, 2014, and is now being granted final approval. Basaglar is not approved as a biosimilar product.

Basaglar is manufactured by Eli Lilly and Company in Indianapolis, Indiana.

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