Lexicon Loses Appeal of FDA ‘Complete Response’

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FDA’s Office of New Drugs has denied a Lexicon Pharmaceuticals appeal of a March Complete Response Letter on its NDA for Zynquista (sotagliflozin), a dual SGLT1 and SGLT2 inhibitor for adults with Type 1 diabetes in combination with insulin. Without disclosing FDA’s concerns, the company says the agency reiterated its prior position denying the appeal. Lexicon says it intends to appeal the decision to CDER’s Office of the Director.

In January, FDA’s Endocrinologic and Metabolic Drugs Advisory Committee was spit 8 to 8 on whether the overall benefits of Zynquista (sotagliflozin) outweighed the risks to support approval. Panel members were concerned about a safety signal that FDA raised in a briefing document released in advance of the meeting. Medical reviewers said a serious adverse event for sotagliflozin is the consistent and clinically meaningful increase in the risk of diabetic ketoacidosis (DKA) compared to placebo observed in all three Phase 3 clinical trials. “While all patients with Type 1 diabetes may to some degree be at risk for DKA, sotagliflozin therapy clearly increases that risk, and the risk may be unpredictable,” they said.

The companies offered FDA a risk management plan that included doctor and patient education (including emphasis on more frequent testing and recognizing early signs of DKA), but some panel members expressed concern that this could be inadequate in a real-world setting.

 

 

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