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FDA panel backs Bristol diabetes drug after prior rejection

By Ransdell Pierson

(Reuters) - By a lopsided vote of 13 to 1, an independent committee of medical experts voted on Thursday to recommend approval of a new type of diabetes drug from Bristol-Myers Squibb that U.S. regulators rejected two years ago due to safety concerns.

The advisory panel to the U.S. Food and Drug Administration said the benefits of the medicine, called dapaglifozin, appear to outweigh its risks. Bristol-Myers is developing the drug, which is already approved in Europe, in partnership with AstraZeneca Plc.

The FDA typically follows the advice of its advisory panels, but is under no obligation to do so.

In another vote, by 10 to 4, the panel found the drug appeared to have a favorable cardiovascular safety profile.

The FDA rejected the medicine in January 2012 after a previous medical advisory panel said clinical data did not provide enough certainty about its cancer and heart risks.

Some members of the panel, in a day-long meeting on Thursday, expressed concern that 10 patients taking dapaglifozin in a large trial were later diagnosed with bladder cancer.

But other panel members said six of those cases occurred within months after treatment began, and were therefore probably not related to the drug because the cancer typically takes years to develop.

Others noted that the overall incidence of all cancers in patients taking dapaglifozin was similar to the overall incidence seen in patients who received placebos.

"I don't think we can dismiss it," referring to the bladder cancer risk, said panel member Dr. Milton Packer, a cardiologist and chairman of clinical sciences with the University of Texas Southwestern Medical Center in Dallas.

Packer said he was counting on the FDA to require the possible bladder risk to be included in the drug's package insert label.

"I actually really like this drug," Packer said, noting that the diabetes drug lowers blood pressure and causes weight loss, unlike many diabetes drugs that cause weight gain.

Bristol-Myers and AstraZeneca Plc in July resubmitted their U.S. marketing application for dapaglifozin for treatment of adults with type 2 diabetes, the most common form of diabetes that is highly linked to obesity.

The revised application included data from several new studies and additional long-term data from studies previously submitted to the FDA.

The drug blocks SGLT2, a protein that works independently of insulin to lower blood sugar. By blocking the kidney from reabsorbing blood sugar, the drug spurs removal of glucose through the urine.

Dapaglifozin is sold in Europe under the brand name Forxiga. If approved in the United States, Cowen and Co. expects the medicine to generate annual sales of $700 million by 2020, amid competition from similar drugs such as Johnson & Johnson's recently approved Invokana (canaglifozin).

Invokana stirred excitement in one large trial by controlling blood sugar better than Merck & Co's Januvia, a blockbuster drug that belongs to a different and relatively new class of diabetes treatments called DPP4 inhibitors.

(Reporting by Ransdell Pierson; Editing by Bernard Orr and Dan Grebler)

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