Isis Pharmaceuticals, Inc. announced positive data from a phase 2 study of ISIS-GCGRRx in patients with type 2 diabetes uncontrolled on stable metformin therapy. In this study, patients in the per protocol efficacy population treated with ISIS-GCGRRx achieved statistically significant reductions in measures of glucose control. The absolute mean reductions in haemoglobin A1c (HbA1c) were greater than 2 percentage points (p=0.001) and greater than 1 percentage points (p=0.001) in the 200 mg and 100 mg cohorts, respectively, compared to baseline after 13 weeks of treatment. Patients treated with ISIS-GCGRRx also experienced increased plasma GLP-1 levels. Isis will present additional detail from this study as a late-breaking abstract programme at the American Diabetes Association 74th Scientific Sessions. In conjunction, Isis will host an investor event on June 15, 2014.

"These results reported represent the potential for a major advance in diabetes therapeutics. ISIS-GCGRRx employs a unique mechanism to treat patients with type 2 diabetes. It is well known that as type 2 diabetes progresses, dysregulated glucagon action becomes a more significant contributor to the disease. The ability of ISIS-GCGRRx to improve glycemic control without causing any clinically significant increases in blood pressure or lipids offers a significant advantage for both patients and treating physicians," said Robert Henry, managing director, chief, VA endocrinology & metabolism and professor of medicine in residence, University of California, San Diego School of Medicine. "The additional effect on increasing GLP-1 means that ISIS-GCGRRx treatment could help to preserve pancreatic function and enhance insulin secretion in diabetic patients."

"Glucagon is a hormone that opposes the action of insulin and causes increased glucose production from the liver. In patients with advanced diabetes, uncontrolled glucagon action can lead to a significant increase in blood glucose levels. Therefore, attenuating glucagon action should have a significant glucose lowering effect in patients with severe diabetes," said Sanjay Bhanot, managing director, vice president of clinical development and translational medicine at Isis. "Unlike results with previous small molecule inhibitors of glucagon receptor, patients treated with ISIS-GCGRRx did not experience significant changes in LDL-C, blood pressure or body weight gain.

This Phase 2 study of ISIS-GCGRRx was a double-blinded, randomized, placebo-controlled study in 75 patients with type 2 diabetes who had uncontrolled blood sugar despite treatment with stable metformin therapy. Patients received either 100 mg or 200 mg of ISIS-GCGRRx or placebo for 13 weeks added to their stable doses of metformin. In this study, the average incoming HbA1c level was 8.7 per cent. After only 13 weeks of dosing, robust and sustained, dose-dependent, statistically significant mean reductions in HbA1c were achieved in patients treated at both doses. Additional measures of glucose control, including serum fructosamine and fasting plasma glucose levels were also significantly reduced in patients treated with ISIS-GCGRRx. The observed improvement in glucose control was in addition to those achieved with each patient's existing therapeutic regimen of metformin.

ISIS-GCGRRx was generally well tolerated in the study. The most common adverse event was infrequent injection site reactions, which were predominantly mild and typically resolved rapidly. There were no flu-like symptoms, no abnormalities in renal function, no clinically meaningful changes in other laboratory values and no cases of symptomatic hypoglycemia. As has been observed with small molecule inhibitors of glucagon receptor, liver enzyme elevations that were not associated with elevated bilirubin or other indicators of liver damage were observed. These liver enzyme elevations are consistent with the pharmacology of glucagon receptor inhibition. ISIS-GCGRRx was not associated with increases in LDL-C, blood pressure or body weight gain (side effects associated with some small molecule inhibitors of glucagon receptor). Additionally, we do not expect ISIS-GCGRRx to produce drug-drug interactions, which means ISIS-GCGRRx has the potential to be used in combination with currently available therapies. ISIS-GCGRRx is a dual acting drug designed to effectively balance reduction of hepatic glucose production and GLP-1 increases. The increases in GLP-1 observed in this study are consistent with our preclinical and Phase 1 experience with ISIS-GCGRRx and support the dual action of ISIS-GCGRRx. Given the remarkable results we have observed in this 13 week study, we plan to optimise dose and dosing schedules for our longer-term studies of ISIS-GCGRRx in patients with type 2 diabetes."

This Phase 2 study of ISIS-GCGRRx was a double-blinded, randomized, placebo-controlled study in 75 patients with type 2 diabetes who had uncontrolled blood sugar despite treatment with stable metformin therapy. Patients received either 100 mg or 200 mg of ISIS-GCGRRx or placebo for 13 weeks added to their stable doses of metformin. In this study, the average incoming HbA1c level was 8.7 per cent. After only 13 weeks of dosing, robust and sustained, dose-dependent, statistically significant mean reductions in HbA1c were achieved in patients treated at both doses. Additional measures of glucose control, including serum fructosamine and fasting plasma glucose levels were also significantly reduced in patients treated with ISIS-GCGRRx. The observed improvement in glucose control was in addition to those achieved with each patient's existing therapeutic regimen of metformin.

ISIS-GCGRRx was generally well tolerated in the study. The most common adverse event was infrequent injection site reactions, which were predominantly mild and typically resolved rapidly. There were no flu-like symptoms, no abnormalities in renal function, no clinically meaningful changes in other laboratory values and no cases of symptomatic hypoglycemia. As has been observed with small molecule inhibitors of glucagon receptor, liver enzyme elevations that were not associated with elevated bilirubin or other indicators of liver damage were observed. These liver enzyme elevations are consistent with the pharmacology of glucagon receptor inhibition. ISIS-GCGRRx was not associated with increases in LDL-C, blood pressure or body weight gain (side effects associated with some small molecule inhibitors of glucagon receptor).

ISIS-GCGRRx is a part of Isis' metabolic franchise that also includes ISIS-PTP1BRx and ISIS-GCCRRx. Each of these drugs is designed to act through a distinct mechanism to improve insulin sensitivity and/or reduce glucose production in patients with type 2 diabetes. Isis is developing ISIS-GCGRRx for patients with advanced diabetes whose glucose is uncontrolled with current therapies.