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Type 1

FDA Decides Not to Approve Farxiga for People with Type 1 Diabetes

For now, another SGLT-2 inhibitor pill already approved for people with type 2 diabetes is not approved for people with type 1 diabetes in the US. The drug was recently approved for type 1 diabetes in Europe and Japan​

By Emma Ryan

The FDA has decided not to approve Farxiga, an SGLT-2 inhibitor pill, for adults with type 1 diabetes. For now, this means that Farxiga's manufacturer, AstraZeneca, will need to work with the FDA to understand what additional information is needed to support approval for type 1 diabetes in the US.

Farxiga is from a class of drugs called “SGLT-2 inhibitors,” a once-daily pill that causes the kidneys to excrete excess glucose through the urine. These drugs work independent of insulin, improve time-in-range, reduce body weight, and improve blood pressure. SGLT-2 inhibitors are currently approved for people with type 2 diabetes, and some people with type 1 diabetes take them “off label” (with the oversight of a medical professional).

This decision from the FDA follows a similar decision earlier this year, when the FDA also decided not to approve Zynquista, an SGLT-1/2 dual inhibitor, for people with type 1 diabetes.

In contrast, the European Medicines Agency (EMA) has approved Farxiga and Zynquista in Europe for adults with type 1 and a body mass index above 27 (see here for a BMI calculator). While we do not have the detailed reasoning behind Europe’s BMI requirement, we have heard that people with a higher BMI are at lower risk for diabetic ketoacidosis (DKA), which is the main safety concern about people with type 1 using SGLT inhibitors. (See our infographic on reducing risk for DKA here.)

For now, the timing on official approval of these drugs for type 1 diabetes in the US is unclear. It’s possible that the FDA will observe the experience in Europe and adopt similar BMI-based labeling in the US.  

For more background on SGLT inhibitors for type 1 diabetes, see our previous writing: