Type 1 Diabetes—Reaping the Rewards of a Targeted Research Investment

Judith E. Fradkin; Julie A. Wallace; Beena Akolkar; Griffin P. Rodgers


Diabetes. 2016;65(2):307-313. 

In This Article

New Therapies for Diabetic Complications

The targeted funding also spurred therapeutic development for microvascular complications common to both type 1 and type 2 diabetes, including studies of lower-cost generic drugs unlikely to receive industry support. With SDP support, the Diabetic Retinopathy Clinical Research Network (DRCR.net) compared three anti–vascular endothelial growth factor (VEGF) intraocular drug treatments for diabetic macular edema: Eylea (aflibercept), Avastin (bevacizumab), and Lucentis (ranibizumab).[10] In this study, Eylea was more effective at improving vision compared with Avastin and Lucentis in people whose starting vision was 20/50 or worse. Patients with milder vision loss, who comprised half the study population, also had substantial visual acuity improvement, but results were similar with all three anti-VEGF treatments. No major differences in the safety of the three drugs were found. On the basis of Medicare allowable charges, the per-injection costs of each drug at the doses used in this study were about $1,960 for Eylea, about $1,200 for Lucentis, and about $70 for Avastin; most patients required 10–12 injections. Thus, these results offer important data for informing clinical decisions and personalizing treatment for diabetic macular edema and also have significant cost implications. Another key finding from the study is that anti-VEGF therapy actually improves vision, as compared with laser treatment that is effective in preventing blindness but does not improve vision and often somewhat worsens it in the short term. Improving vision with anti-VEGF therapy can make the difference between people being able to drive or not, which greatly affects quality of life.

The NIH and SDP roles in this study are noteworthy as the private sector is unlikely to undertake the comparison of drugs from different companies with large cost savings. Another new clinical trial not of interest to the pharmaceutical industry is the testing of the generic gout drug allopurinol for the preservation of kidney function in people with type 1 diabetes at high risk of kidney disease. Despite the efficacy of glucose and blood pressure control and ACE blockade in reducing the risk of diabetic nephropathy, rates of diabetic nephropathy remain high. Moreover, no new therapy has emerged in the past two decades. On the basis of strong preliminary data, a multicenter trial of allopurinol to slow the progression of nephropathy in type 1 diabetes was recently launched by the Preventing Early Renal Loss in Diabetes (PERL) Consortium with full support by the SDP.[11] If this safe and inexpensive drug proves effective, allopurinol may also be relevant to renal protection in the larger population with type 2 diabetes.