Jardiance can both reduce cardiovascular events and relieve renal dysfunction

Eli Lilly and BI today announced that their type 2 diabetes drug SGLT2 inhibitor Jardiance also can alleviate renal dysfunction besides displaying the cardiovascular benefits. This is the secondary endpoint of prospective clinical trial called EMPA-REG. The primary end point of this four-stage clinical trial involved in 7,000 people is cardiovascular events. After tracking for average 3.1 years, the results showed that compared with placebo, the combination of standard therapy and Jardiance were more capable to reduce myocardial infarction, death from heart disease and stroke risk. What is announced today at ADA and published in the NEJM this experiment is the secondary endpoint. And the combination of standard therapy and Jardiance reduced 39% of renal injury or worsening of renal impairment (urine protein / creatinine ratio> 300, creatinine doubling) compared with placebo. More importantly, Jardiance reduced the number of patients who started dialysis by55%. Jardiance becomes the first hypoglycemic drug which can both reduce cardiovascular events and relieve renal dysfunction after a lot of research with different recombinant proteins.

Although this is the first hypoglycemic drug that can relieve renal dysfunction, there are a few precautions. First, these observations are secondary endpoint of EMPA-REG but not the main outcome indexes of the trial; second, these indexes of renal function are also indexes of blood glucose, so they just have no great distinction. Delay of kidney dialysis is the real index for patients' living. Although Jardiance reduces the risk by 55%, the absolute risk is not great from 0.6% to 0.3%. The main reason is that the majority of them are patients with early kidney damage and the tracking time is only 3.1 years which was much shorter.

However, this is still an important progress. 35% of people with diabetes would have kidney dysfunction, which is a major complication of diabetes. Renal dysfunction is a great market and it is estimated that 10% of Americans have varying degrees of renal dysfunction. There are no drugs which are very effective to treat renal dysfunction except some traditional antihypertensive drugs, so drug with new mechanism is an important contribution to this population.

Now there are two types of drugs which can improve cardiovascular event and Jardiance has been shown to improve renal dysfunction. Although the efficacy of these drugs to improve the prognosis is still relatively minor, this undoubtedly establishes a higher standard for future hypoglycemic drugs. Later, hypoglycemic drugs which only lower blood glucose may be not enough. That's why Merck recently doubled safety trials into efficacy test and stopped the long-term development of DPP4 inhibitor.

Before people are not optimistic about SGLT as hypoglycemic mechanism and think that cannot be alone to treat diabetes glucosuria out. Diabetes is not just glucose, but SGLT would not just inhibit glucose reabsorption. With our in-depth understanding of diabetes, we would know that diabetes will prove to be the same as and cancer which is a combination of a variety of diseases. In the future, the pre-clinical studies need more complex scientific hypotheses and optimization methods, and clinical development needs to draw precise medical experience of the tumor. With the help of recombinant mouse proteins like recombinant Cdh8, we can find the real beneficiaries according to the mechanism tags, and not all people with glucose abnormality can use.