Drug Trials Snapshots: INPEFA
HOW TO USE THIS SNAPSHOT
The information provided in Snapshots highlights who participated in the key clinical trials that supported the original FDA approval of this drug, and whether there were differences among sex, race, age, and ethnic groups. The “MORE INFO” bar shows more detailed, technical content for each section. The Snapshot is intended as one tool for consumers to use when discussing the risks and benefits of the drugs.
LIMITATIONS OF THIS SNAPSHOT:
Do not rely on Snapshots to make decisions regarding medical care. Always speak to your healthcare provider about the benefits and risks of a drug.
Some of the information in this Snapshot is for presentation purposes and does not represent the approved conditions of use of this drug. Refer to the INPEFA Prescribing Information for all of the approved conditions of use of this drug (e.g., indication(s), population(s), dosing regimen(s), safety information).
Snapshots are limited to the information available at the time of the original approval of the drug and do not provide information on who participated in clinical trials that supported later approvals for additional uses of the drug (if applicable).
INPEFA (sotagliflozin)
In peh’ fah
Lexicon Pharmaceuticals, Inc.
Original Approval date: May 26, 2023
DRUG TRIALS SNAPSHOT SUMMARY:
What is the drug for?
INPEFA is a drug that reduces the risk of cardiovascular death, hospitalization for heart failure, and urgent heart failure visit in adults with:
- heart failure or
- type 2 diabetes mellitus, chronic kidney disease, and other cardiovascular risk factors
How is this drug used?
INPEFA is a tablet that is taken by mouth once daily.
Who participated in the clinical trials?
The FDA approved INPEFA based on evidence from two clinical trials of 11,806 total patients with heart failure or with type 2 diabetes mellitus, chronic kidney disease, and other cardiovascular risk factors. The trials were conducted at 322 sites in 32 countries (SOLOIST) and 750 sites in 42 countries (SCORED) primarily in Europe, South America, and North America. Both trials were used for primary determination of the benefits and side effects of the drug.
How were the trials designed?
The benefits and side effects of INPEFA were evaluated in two clinical trials of 11,806 total patients with heart failure (SOLOIST) or with type 2 diabetes mellitus, chronic kidney disease, and other cardiovascular risk factors (SCORED).
In both trials, patients were randomly assigned to receive either INPEFA or placebo by mouth once a day. Neither the patients nor the healthcare providers knew which treatment was being given until after the trial was completed.
The benefit of INPEFA was evaluated by measuring the number of predefined events (death from cardiovascular causes, need for hospitalization for heart failure, or urgent medical care visit for heart failure) occurring in the patient population receiving INPEFA versus placebo.
How were the trials designed?
The SOLOIST study (NCT03521934) was a randomized, double-blind, placebo-controlled, parallel-group, multicenter study in patients with type 2 diabetes mellitus who had been admitted to a hospital, heart failure unit, infusion center, or emergency department for worsening heart failure. Patients were randomized to treatment if they met the following criteria for clinical stability: no need for oxygen therapy, a systolic blood pressure of at least 100 mmHg, no need for intravenous inotropic or vasodilator therapy (excluding nitrates), and had transitioned from intravenous to oral diuretic therapy. Of the 1,222 randomized patients, 608 were randomized to INPEFA and 614 to placebo. Assigned treatment was initiated in the hospital or within a median of two days following hospital discharge.
The dose of the study drug was to be up-titrated from 200 mg to 400 mg of INPEFA or matching placebo as soon as two weeks or up to eight months after initiation of treatment. The dose was increased to 400 mg once daily for 336 patients (56%) in the INPEFA group and 325 patients (53%) in the placebo group. The median time to up-titration was 16 days.
The SCORED study (NCT03315143) was a randomized, double-blind, placebo-controlled, parallel group, multicenter study in patients with type 2 diabetes mellitus (A1C >7%), chronic kidney disease (eGFR 25 to 60 mL/min/1.73 m2), and additional cardiovascular risk factors, such as a history of heart failure, obesity, dyslipidemia, hypertension, or elevated cardiac and inflammatory biomarkers. Of the 10,584 randomized patients, 5,292 were randomized to INPEFA and 5,292 to placebo.
The dose of study drug was to be up-titrated from 200 mg to 400 mg of INPEFA or matching placebo as soon as four weeks or up to six months after initiation of treatment. The dose was increased to 400 mg once daily for 3,934 patients (74%) in the INPEFA group and for 3,987 patients (75%) in the placebo group. The median time to up-titration was 29 days.
Up-titration in both trials was to be performed based on the judgment of the investigator, who considered whether the patient’s clinical condition was satisfactory, whether the drug was well tolerated, and whether adverse events typical of SGLT2 inhibitors had occurred, such as those associated with volume depletion.
The primary endpoint in both trials was the total occurrence of cardiovascular death, hospitalization for heart failure, and urgent heart failure visit.
DEMOGRAPHICS SNAPSHOT
Figure 1, Figure 2, Figure 3, and Figure 4 display the percentage of patients by sex, race, age, and ethnicity enrolled in SOLOIST and SCORED trials, respectively.
Figure 1. Baseline Demographics by Sex in SOLOIST and SCORED Trials
Source: Adapted from FDA Review
Figure 2. Baseline Demographics by Race in SOLOIST and SCORED Trials
Source: Adapted from FDA Review
Figure 3. Baseline Demographics by Age in SOLOIST and SCORED Trials
Source: Adapted from FDA Review
Figure 4. Baseline Demographics by Ethnicity in SOLOIST and SCORED Trials
Source: Adapted from FDA Review
Who participated in the trials?
Table 1 . Baseline Demographics
Subgroup |
INPEFA |
Placebo |
Overall |
---|---|---|---|
Sex |
|||
Male |
3355 (56.9) |
3285 (55.6) |
6640 (56.2) |
Female |
2545 (43.1) |
2621 (44.4) |
5166 (43.8) |
Age, years |
|||
<65 |
1775 (30) |
1813 (31) |
3588 (31) |
≥65 |
4125 (70) |
4093 (69) |
8218 (69) |
Race |
|||
White |
4950 (84) |
4901 (83) |
9851 (83) |
Black |
201 (3) |
212 (4) |
413 (3) |
Asian |
325 (6) |
372 (6) |
697 (6) |
American Indian or Alaska Native |
205 (3) |
216 (4) |
421 (4) |
Other* |
219 (4) |
205 (3) |
424 (4) |
Ethnicity |
|||
Hispanic or Latino |
1834 (31) |
1835 (31) |
3669 (31) |
Not Hispanic or Latino |
4031 (68) |
4036 (68) |
8067 (68) |
Other** |
35 (1) |
35 (1) |
70 (1) |
Source: Adapted from FDA Review
* Includes: Native Hawaiian (n=44); Multiple (n=245); Not reported (67); Unknown (58); Missing (n=10)
** Includes: Not reported (n=47); Unknown (22); Missing (n=1)
What are the benefits of this drug?
In patients with heart failure or those with type 2 diabetes mellitus, chronic kidney disease, and other cardiovascular risk factors, INPEFA reduced the risk of dying from cardiovascular causes and need for hospitalization and urgent medical care visit for heart failure.
What are the benefits of this drug (results of trials used to assess efficacy)?
The benefit of INPEFA was determined through two cardiovascular outcome trials, SOLOIST and SCORED.
SOLOIST (N=1222) demonstrated that patients hospitalized for heart failure symptoms, who had either a pre-existing heart failure diagnosis or new heart failure diagnosis, had a statistically significant reduction in the risk of the composite endpoint (cardiovascular death, hospitalization for heart failure, or urgent heart failure visit) when treated with INPEFA (N=608) as compared to placebo (N=614). INPEFA reduced the risk of cardiovascular death, hospitalization for heart failure, or urgent heart failure visit by 33% compared to placebo in patients with heart failure (Table 2).
Table 2. Treatment Effect of INPEFA on Primary Efficacy Composite, Components, and Secondary Endpoint in the SOLOIST Study
Endpoint |
Event Rates per 100 PY |
|
p-Value |
|
---|---|---|---|---|
INPEFA |
Placebo |
|||
Primary endpointa |
||||
Total occurrence of cardiovascular |
51.3 |
76.4 |
0.67 (0.53, 0.85) |
0.001 |
Primary endpoint components |
||||
Cardiovascular deathc,d |
8.4 |
9.4 |
0.84 (0.58, 1.23) |
NA |
Hospitalization for heart failure |
33.7 |
51.9 |
0.65 (0.49, 0.87) |
NA |
Urgent heart failure visit |
6.9 |
12.1 |
0.60 (0.34, 1.06) |
NA |
Secondary endpointc |
||||
Hospitalization for heart failure and |
40.6 |
63.9 |
0.64 (0.50, 0.84) |
0.0009 |
Source: Adapted from INPEFA Prescribing Information
a Based on investigator reported events in all randomized patients, analyzed according to the treatment group allocated by randomization.
b Predefined primary endpoint.
c Predefined secondary endpoint and tested with multiplicity control.
d Time-to-event analysis was performed; event rates are percentages of patients with events.
Abbreviations: CI, confidence interval; NA, not applicable; PY, patient-years
SCORED (N=10,584) demonstrated that patients with a current diagnosis of type 2 diabetes mellitus, chronic kidney disease, and other cardiovascular risk factors had a statistically significant reduction in the risk of the composite endpoint (cardiovascular death, hospitalization for heart failure, or urgent heart failure visit) when treated with INPEFA (N=5,292) as compared to placebo (N=5,292). INPEFA reduced the risk of cardiovascular death, hospitalization for heart failure, or urgent heart failure visit by 25% compared to placebo in patients with type 2 diabetes mellitus, chronic kidney disease, and other cardiovascular risk factors (Table 4).
Table 3. Treatment Effect of INPEFA on Primary Efficacy Composite, Components, and Secondary Endpoint in the SCORED Study
Endpoint |
Event Rates per 100 PY |
|
p-Value |
|
---|---|---|---|---|
INPEFA |
Placebo |
|||
Primary endpointa |
||||
Total occurrence of cardiovascular |
5.6 |
7.5 |
0.75 (0.63, 0.88) |
<0.001 |
Primary endpoint components |
||||
Cardiovascular deathc,d |
2.9 |
3.2 |
0.90 (0.73, 1.12) |
NA |
Hospitalization for heart failure |
2.8 |
4.2 |
0.66 (0.53, 0.82) |
NA |
Urgent heart failure visit |
0.7 |
0.9 |
0.73 (0.48, 1.11) |
NA |
Secondary endpointc |
||||
Hospitalization for heart failure and |
3.5 |
5.1 |
0.67 (0.55, 0.82) |
0.0001 |
Source: Adapted from INPEFA Prescribing Information
a Based on investigator reported events in all randomized patients, analyzed according to the treatment group allocated by randomization.
b Predefined primary endpoint.
c Predefined secondary endpoint and tested with multiplicity control.
d Time-to-event analysis was performed; event rates are percentages of patients with events.
Abbreviations: CI, confidence interval; NA, not applicable; PY, patient-years
In both trials, the benefit shown for the composite endpoint was primarily driven by reductions in the hospitalization for heart failure component with favorable trends for both cardiovascular death and urgent heart failure visit.
Were there any differences in how well the drug worked in clinical trials among sex, race and age?
- Sex: INPEFA worked similarly in males and females.
- Race: INPEFA worked similarly in White and Black patients. The number of patients of other races was too small; therefore , differences in how INPEFA worked among other races could not be determined .
- Ethnicity: INPEFA worked similarly in patients regardless of ethnicity.
- Age: INPEFA worked similarly in patients younger and older than 65 years of age.
Were there any differences in how well the drug worked in clinical trials among sex, race, and age groups?
The benefit of INPEFA was consistent across subgroups of sex and age.
Table 4 and Table 5 summarize how well INPEFA worked in the trials among sex and age groups.
Table 4. Effect of INPEFA on Reducing the Risk of Primary Composite Outcomea by Sex, Age and Race Subgroups in the SOLOIST Study
Subgroup |
Number of Events (Event Rates per 100 PY) |
Hazard Ratio |
|
---|---|---|---|
INPEFA |
Placebo |
||
Sex |
|||
Male |
176 (56.1) |
271 (90.0) |
0.64 (0.37, 0.90) |
Female |
69 (42.0) |
84 (51.9) |
0.75 (0.35, 1.14) |
Age, years |
|||
<65 |
90 (57.4) |
95 (70.9) |
0.75 (0.36, 1.13) |
≥65 |
155 (48.3) |
260 (78.6) |
0.63 (0.36, 0.90) |
Race |
|||
White |
206 (46.4) |
318 (72.9) |
0.65 (0.40, 0.90) |
Black |
32 (153.9) |
27 (173.2) |
0.95 (0.28, 1.63) |
Asian |
0 (0) |
2 (55.3) |
0 (0,0) |
Ethnicity |
|||
Hispanic or Latino |
64 (51.9) |
91 (81.4) |
0.60 (0.21, 0.99) |
Not Hispanic or Latino |
175 (49.8) |
263 (74.8) |
0.68 (0.41, 0.94) |
Source: Adapted from FDA Review
a Primary composite outcome includes cardiovascular death, hospitalization for heart failure, and urgent heart failure visit
b Treatment differences and credible intervals may not match values of (INPEFA - Placebo) since estimates include relevance of outcomes from other subgroups
Abbreviations: CI, credible interval; PY, patient-years
Table 5. Effect of INPEFA on Reducing the Risk of Primary Composite Outcomea by Sex and Age Subgroups in the SCORED Study
Subgroup |
Number of Events (Event Rates per 100 PY) |
Hazard Ratio |
|
---|---|---|---|
INPEFA |
Placebo |
||
Sex |
|||
Male |
238 (6.1) |
320 (8.3) |
0.73 (0.54, 0.93) |
Female |
162 (5.1) |
210 (6.5) |
0.76 (0.53, 0.98) |
Age, years |
|||
<65 |
80 (3.8) |
136 (6.3) |
0.64 (0.34, 0.93) |
≥65 |
320 (6.4) |
394 (7.9) |
0.77 (0.60, 0.94) |
Race |
|||
White |
346 (5.7) |
454 (7.7) |
0.75 (0.58, 0.91) |
Black |
17 (7.1) |
26 (10.7) |
0.78 (0.30, 1.25) |
Asian |
23 (6.7) |
2 (5.4) |
0.89 (0.40, 1.38) |
Ethnicity |
|||
Hispanic or Latino |
88 (1.8) |
118 (2.4) |
0.74 (0.57, 0.91) |
Not Hispanic or Latino |
309 (6.2) |
309 (6.2) |
0.75 (0.46, 1.03) |
Source: Adapted from FDA Review
a Primary composite outcome includes cardiovascular death, hospitalization for heart failure, and urgent heart failure visit
b Treatment differences and credible intervals may not match values of (INPEFA - Placebo) since estimates include relevance of outcomes from other subgroups
Abbreviations: CI, credible interval; PY, patient-years
What are the possible side effects?
In patients with type 1 diabetes mellitus, INPEFA significantly increases the risk of diabetic ketoacidosis, a life-threatening event, beyond the background rate. Diabetic ketoacidosis is a serious, potentially life-threatening complication that occurs when the body produces high levels of acids called ketones in the blood. Type 2 diabetes mellitus and pancreatic disorders (e.g., history of pancreatitis or pancreatic surgery) are also risk factors for ketoacidosis.
The most common side effects with INPEFA are urinary tract infection, volume depletion, diarrhea, and low blood sugar levels.
What are the possible side effects (results of trials used to assess safety)?
Table 6 summarizes common adverse reactions for the safety population from the SOLOIST and SCORED studies.
Note that for the common adverse events in Table 6, the risks of most of them are only slightly higher on drug than on placebo.
Table 6. Adverse Reactions Reported in ≥2% of Patients Treated With INPEFA and Greater Than Placebo in Either SOLOIST or SCORED
Adverse Reaction |
SOLOIST, N=1216 |
SCORED, N=10577 |
||
---|---|---|---|---|
Placebo |
INPEFA |
Placebo |
INPEFA |
|
Urinary tract infection |
7.2 |
8.6 |
11.0 |
11.5 |
Volume depletion |
8.8 |
9.3 |
4.0 |
5.2 |
Diarrhea |
4.1 |
6.9 |
6.0 |
8.4 |
Hypoglycemia |
2.8 |
4.3 |
7.9 |
7.7 |
Dizziness |
2.5 |
2.6 |
2.8 |
3.3 |
Genital mycotic infection |
0.2 |
0.8 |
0.9 |
2.4 |
Source: INPEFA Prescribing Information
Were there any differences in side effects of the clinical trials among sex, race, and age?
- Sex: More genital yeast infections and events of diarrhea were reported by females compared to males. In the trial, all patients treated with INPEFA had more genital yeast infections and diarrhea compared to patients given placebo.
- Race: The majority of patients were White. The number of patients of other races was limited; therefore, differences in side effects among races could not be determined.
- Age: Patients older than 65 years of age had more side effects related to volume depletion compared to younger patients.
Were there any differences in side effects of the clinical trials among sex, race, and age groups?
Table 7 summarizes common adverse reactions, genital mycotic infections, volume depletion, and diarrhea, by sex, age, and race subgroups based on the safety population from the SOLOIST and SCORED studies.
Table 7. Subgroup Analysis of Common Adverse Reactions (SOLOIST and SCORED)
Subgroup |
SOLOIST, N=1216 |
SCORED, N=10577 |
||
---|---|---|---|---|
Placebo |
INPEFA |
Placebo |
INPEFA |
|
Genital mycotic infections |
||||
Overall |
1 (0.2) |
5 (0.8) |
45 (0.9) |
125 (2.4) |
Sex |
||||
Female |
1 (0.5) |
3 (1.5) |
31 (1.3) |
88 (3.7) |
Male |
0 |
2 (0.5) |
14 (0.5) |
37 (1.3) |
Age group, years |
||||
18 to 64 |
0 |
1 (0.5) |
13 (0.8) |
31 (2.0) |
≥65 |
1 (0.2) |
4 (1.0) |
32 (0.9) |
94 (2.5) |
Race |
||||
White |
1 (0.2) |
4 (0.7) |
35 (0.8) |
112 (2.6) |
Black or African American |
0 |
0 |
6 (3.2) |
5 (2.8) |
Asian |
0 |
1 (12.5) |
1 (0.3) |
3 (0.9) |
Other |
0 |
0 |
2 (0.6) |
3 (0.8) |
Missing |
0 |
0 |
1 (1.5) |
2 (3.5) |
Volume depletion |
||||
Overall |
54 (8.8) |
56 (9.3) |
213 (4.0) |
277 (5.2) |
Sex |
||||
Female |
16 (7.5) |
17 (8.6) |
72 (3.0) |
106 (4.5) |
Male |
38 (9.5) |
39 (9.6) |
141 (4.9) |
171 (5.8) |
Age group, years |
||||
18 to 64 |
13 (7.6) |
11 (5.7) |
57 (3.5) |
60 (3.8) |
≥65 |
41 (9.3) |
45 (10.9) |
156 (4.3) |
217 (5.9) |
Race |
||||
White |
50 (8.8) |
51 (9.0) |
175 (4.0) |
246 (5.6) |
Black or African American |
3 (12.5) |
3 (12.0) |
11 (5.9) |
8 (4.5) |
Asian |
0 |
1 (12.5) |
11 (3.0) |
9 (2.8) |
Other |
1 (25.0) |
1 (50.0) |
12 (3.5) |
12 (3.3) |
Missing |
0 |
0 |
4 (6.1) |
2 (3.5) |
Diarrhea |
||||
Overall |
25 (4.1) |
42 (6.9) |
315 (6.0) |
447 (8.4) |
Sex |
||||
Female |
10 (4.7) |
18 (9.1) |
141 (5.9) |
219 (9.3) |
Male |
15 (3.8) |
24 (5.9) |
174 (6.0) |
228 (7.7) |
Age group, years |
||||
18 to 64 |
6 (3.5) |
9 (4.7) |
98 (6.0) |
129 (8.2) |
≥65 |
19 (4.3) |
33 (8.0) |
217 (6.0) |
318 (8.6) |
Race |
||||
White |
24 (4.2) |
37 (6.6) |
257 (5.9) |
354 (8.1) |
Black or African American |
1 (4.2) |
3 (12.0) |
7 (3.8) |
18 (10.2) |
Asian |
0 |
2 (25.0) |
15 (4.1) |
23 (7.3) |
Other |
0 |
0 |
28 (8.1) |
41 (11.4) |
Missing |
0 |
0 |
8 (12.1) |
11 (19.3) |
Source: Adapted from FDA Review
GLOSSARY
CLINICAL TRIAL: Voluntary research studies conducted in people and designed to answer specific questions about the safety or effectiveness of drugs, vaccines, other therapies, or new ways of using existing treatments.
COMPARATOR: A previously available treatment or placebo that is compared to the actual drug being tested.
EFFICACY: How well the drug achieves the desired response when it is taken as described in a controlled clinical setting, such as during a clinical trial.
PLACEBO: An inactive substance or “sugar pill” that looks the same as, and is given the same way as, an active drug or treatment being tested. The effects of the active drug or treatment are compared to the effects of the placebo.
SUBGROUP: A subset of the population studied in a clinical trial. Demographic subsets include sex, race, and age groups.