Sun Pharma Laboratories and Alkem Laboratories have both received the green light from the Subject Expert Committee (SEC) under the Central Drug Standard Control Organisation (CDSCO) to advance their respective semaglutide injection solutions into Phase III clinical trials. These approvals come with a significant modification to the study design, mandating retinal examinations (fundoscopies) at every visit to monitor potential retinal complications.
The decision follows presentations by both companies of their bioequivalence (BE) study reports and revised Phase III clinical trial protocols for type 2 diabetes mellitus. The SEC for Endocrinology and Metabolism, which convened on January 13, 2025, carefully reviewed the data before issuing its recommendations.
Enhanced Monitoring for Retinal Safety
The requirement for retinal examinations at each visit underscores the importance of monitoring potential ophthalmic side effects associated with GLP-1 receptor agonists like semaglutide. While semaglutide offers significant benefits in managing blood sugar and reducing cardiovascular risk, vigilance regarding retinal health is paramount.
Semaglutide's Mechanism of Action
Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, mimics the GLP-1 hormone released in response to eating. By activating GLP-1 receptors, semaglutide enhances insulin secretion in a glucose-dependent manner, inhibits glucagon release, and suppresses hepatic gluconeogenesis. These mechanisms collectively contribute to reducing both fasting and postprandial glucose levels.
Clinical Significance and Trial Objectives
Semaglutide injection is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. It is also approved to reduce the risk of major adverse cardiovascular events (MACE) in adults with type 2 diabetes and established cardiovascular disease.
The Phase III trials will further evaluate the efficacy and safety of Sun Pharma's and Alkem's semaglutide injection formulations. Specifically, Alkem Laboratories presented data for an additional strength of Semaglutide Injection 2 mg {(8mg/3ml) (2.68mg/ml)}.
