toujeo ® and it’s place in therapy sharmon p. osae, pharmd richard l. roudebush va medical center...
TRANSCRIPT
![Page 1: Toujeo ® and it’s Place in Therapy Sharmon P. Osae, PharmD Richard L. Roudebush VA Medical Center / Purdue University PGY-2 Ambulatory Care / Education](https://reader035.vdocuments.site/reader035/viewer/2022062408/56649f005503460f94c15ab8/html5/thumbnails/1.jpg)
Toujeo® and it’s Place in TherapySharmon P. Osae, PharmD
Richard L. Roudebush VA Medical Center / Purdue University
PGY-2 Ambulatory Care / Education Resident
September 17, 2015
This speaker has no actual or potential conflicts of interest to disclose in relation to this presentation
![Page 2: Toujeo ® and it’s Place in Therapy Sharmon P. Osae, PharmD Richard L. Roudebush VA Medical Center / Purdue University PGY-2 Ambulatory Care / Education](https://reader035.vdocuments.site/reader035/viewer/2022062408/56649f005503460f94c15ab8/html5/thumbnails/2.jpg)
Objectives
At the end of this presentation, the participants will be able to:
Describe the national burden of diabetes on the United States
Compare and contrast insulin glargine formulations and identify recommendations regarding their use
Provide evidence-based recommendations regarding the use of Toujeo in patients with diabetes
![Page 3: Toujeo ® and it’s Place in Therapy Sharmon P. Osae, PharmD Richard L. Roudebush VA Medical Center / Purdue University PGY-2 Ambulatory Care / Education](https://reader035.vdocuments.site/reader035/viewer/2022062408/56649f005503460f94c15ab8/html5/thumbnails/3.jpg)
Epidemiology
Estimated 29.1 million Americans living with diabetes mellitus (DM) Approximately 1.25 million with Type 1 DM
86 million Americans ≥20 years old with pre-diabetes
DM is the 7th leading cause of death in the United states
Centers for Disease Control and Prevention. 2014 National Diabetes Statistics Report;2014.
![Page 4: Toujeo ® and it’s Place in Therapy Sharmon P. Osae, PharmD Richard L. Roudebush VA Medical Center / Purdue University PGY-2 Ambulatory Care / Education](https://reader035.vdocuments.site/reader035/viewer/2022062408/56649f005503460f94c15ab8/html5/thumbnails/4.jpg)
Toujeo®
Mechanism of ActionRegulation of glucose metabolism
Prolonged release of insulin compared to that of insulin glargine (U-100)
IndicationsImprove glycemic control in adults with type 1 and
type 2 DM
• 300 units/ml
• 1.5 ml pen
Toujeo® (package insert).Sanofi-Aventis U.S. LLC; 2015.
![Page 5: Toujeo ® and it’s Place in Therapy Sharmon P. Osae, PharmD Richard L. Roudebush VA Medical Center / Purdue University PGY-2 Ambulatory Care / Education](https://reader035.vdocuments.site/reader035/viewer/2022062408/56649f005503460f94c15ab8/html5/thumbnails/5.jpg)
Dosing
Insulin Naïve Patients
Starting Dose of Toujeo® Frequency
Type 1 DM 0.2-0.4 units/kg/day Once Daily
Type 2 DM 0.2 units/kg/day Once Daily
Insulin Experienced Patients - Conversions
Insulin Conversion Frequency
Once daily long acting (U-100) to Toujeo®
1:1** Once Daily
Twice daily NPH to Toujeo®
Decrease total daily dose of NPH
by 20%
Once Daily
Toujeo® (package insert).Sanofi-Aventis U.S. LLC; 2015.
![Page 6: Toujeo ® and it’s Place in Therapy Sharmon P. Osae, PharmD Richard L. Roudebush VA Medical Center / Purdue University PGY-2 Ambulatory Care / Education](https://reader035.vdocuments.site/reader035/viewer/2022062408/56649f005503460f94c15ab8/html5/thumbnails/6.jpg)
**Caveat**For patients maintained on Lantus® insulin glargine (U-100),
expect a higher daily dose requirement of Toujeo® to maintain the same level of glycemic control
![Page 7: Toujeo ® and it’s Place in Therapy Sharmon P. Osae, PharmD Richard L. Roudebush VA Medical Center / Purdue University PGY-2 Ambulatory Care / Education](https://reader035.vdocuments.site/reader035/viewer/2022062408/56649f005503460f94c15ab8/html5/thumbnails/7.jpg)
Pharmacokinetics
Toujeo® (package insert).Sanofi-Aventis U.S. LLC; 2015.Lantus® (package insert).Sanofi-Aventis U.S. LLC;2015.
Property Toujeo® Lantus®
Onset (hours) 6 4-5
Duration of Action (hours) 24-36 24
Time to Steady State 5 days 24 hours
![Page 8: Toujeo ® and it’s Place in Therapy Sharmon P. Osae, PharmD Richard L. Roudebush VA Medical Center / Purdue University PGY-2 Ambulatory Care / Education](https://reader035.vdocuments.site/reader035/viewer/2022062408/56649f005503460f94c15ab8/html5/thumbnails/8.jpg)
Adverse Effects
No difference between U-100 insulin
Hypoglycemia
Weight gain
Lipodystrophy
Hypokalemia
Injection site reactions
Toujeo® (package insert).Sanofi-Aventis U.S. LLC; 2015.
![Page 9: Toujeo ® and it’s Place in Therapy Sharmon P. Osae, PharmD Richard L. Roudebush VA Medical Center / Purdue University PGY-2 Ambulatory Care / Education](https://reader035.vdocuments.site/reader035/viewer/2022062408/56649f005503460f94c15ab8/html5/thumbnails/9.jpg)
Clinical Data
Type 1 DM26 week open-label randomized controlled trial
Intervention• Toujeo ® once daily + bolus insulin with meals (n=273)
• Lantus ® once daily + bolus insulin with meals (n=273)
Results• Toujeo arm average A1c reduction of 0.4%
• Lantus arm average A1c reduction 0.44%
• Toujeo arm utilized 17.5% more basal insulin
• No differences in body weight
Toujeo® (package insert).Sanofi-Aventis U.S. LLC; 2015.Home PD et al. European Association for the Study of Diabetes Congress 2014, abstract 148.
![Page 10: Toujeo ® and it’s Place in Therapy Sharmon P. Osae, PharmD Richard L. Roudebush VA Medical Center / Purdue University PGY-2 Ambulatory Care / Education](https://reader035.vdocuments.site/reader035/viewer/2022062408/56649f005503460f94c15ab8/html5/thumbnails/10.jpg)
Clinical Data
Type 2 DM26 week open-label randomized controlled study
Intervention• Toujeo once daily + bolus insulin +/- metformin (n=404)
• Lantus once daily + bolus insulin +/- metformin (n=400)
Results• Toujeo arm average A1c reduction of 0.9%
• Lantus arm average A1c reduction 0.87%
• Toujeo arm utilized 11% more basal insulin
• No differences in body weight
Toujeo® (package insert).Sanofi-Aventis U.S. LLC; 2015.Ritzel RA et al. European Association for the Study of Diabetes congress, 2014, abstract 963.
![Page 11: Toujeo ® and it’s Place in Therapy Sharmon P. Osae, PharmD Richard L. Roudebush VA Medical Center / Purdue University PGY-2 Ambulatory Care / Education](https://reader035.vdocuments.site/reader035/viewer/2022062408/56649f005503460f94c15ab8/html5/thumbnails/11.jpg)
Conclusions
Toujeo® is a concentrated formulation of insulin glargine300 units/ml
Trials suggest Toujeo® is as effective as glargine in ↓ A1c ↑ Toujeo® dosages may be needed
to maintain similar glycemic control
![Page 12: Toujeo ® and it’s Place in Therapy Sharmon P. Osae, PharmD Richard L. Roudebush VA Medical Center / Purdue University PGY-2 Ambulatory Care / Education](https://reader035.vdocuments.site/reader035/viewer/2022062408/56649f005503460f94c15ab8/html5/thumbnails/12.jpg)
Toujeo® and it’s Place in Therapy
Sharmon P. Osae, PharmD
Richard L. Roudebush VA Medical Center / Purdue University
PGY-2 Ambulatory Care / Education Resident
September 17, 2015