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FDA Grants NovoLog Category B Pregnancy Rating
Diabetes and its treatment options can present significant challenges for women wishing to conceive and have a healthy pregnancy. As a safety precaution, the FDA classifies prescription drugs with specific category ratings to provide decision-making guidelines for physicians treating pregnant women. The Pregnancy Category B rating for NovoLog(R) indicates that adequate studies in pregnant women with Type 1 diabetes have demonstrated that NovoLog(R) does not increase risk to the unborn baby. Previously, NovoLog(R) was classified as a Category C rating, which indicates that adverse effects on the fetus have been demonstrated in animal reproduction studies, and that adequate and well-controlled studies in pregnant women have not been conducted to demonstrate safety(1).
"While clinical research is rarely conducted in pregnant women, we at Novo Nordisk understand the needs of this special population. The confirmed safety of NovoLog(R) will allow their doctors to make informed decisions about treatment options for people with diabetes," said Martin Soeters, president of Novo Nordisk. "We are excited that the FDA has acknowledged our efforts to advance diabetes treatment and recognizes the value of our insulin analogs such as NovoLog(R)."
The FDA category change was based on a review of the largest ever randomized controlled trial using an insulin analog in pregnant women with type 1 diabetes.
The study, conducted at 63 sites in 18 countries, compared the safety and efficacy of NovoLog(R) versus human regular insulin (HRI) in the treatment of 322 pregnant women with type 1 diabetes. Data demonstrated that changes in HbA1c and rates of maternal hypoglycemia were comparable with NovoLog(R) compared to HRI. The study was not large enough to evaluate the risk of congenital malformations. Compared to HRI, the trial with NovoLog(R) showed improved outcomes for both mother and child in terms of:
- Fewer preterm deliveries (p Reduced risk of neonatal hypoglycemia (glucose Consistently low rates of major hypoglycemia
- Reduced risks to the fetus, with outcomes at least comparable to HRI(2).
Each year in the US, about 18,000 women with pre-existing type 1 or type 2 diabetes(3) become pregnant and 135,000 pregnant women develop gestational diabetes (those who develop high blood sugar during pregnancy(4)). For these pregnant women, insulin is frequently used to manage their diabetes(5).
Diabetes that is not tightly controlled can lead to extensive complications for mother and baby and can cause significant burdens on families and the healthcare system(6):
- For the mother, complications from existing diabetes may worsen and new complications may emerge(7), including greater incidence of miscarriage, high blood pressure, kidney disease and nerve damage(8).
- For the baby, uncontrolled diabetes may mean up to four-times more likelihood of being born with increased infant mortality, preterm birth (and the myriad of problems associated with it), high birth weight(9) or a birth defect(10).
1) Current Categories for Drug Use in Pregnancy," FDA (2006).
(2) Data on file at Novo Nordisk Inc.
(3) Centers for Disease Control and Prevention. Preventing Diabetes and Its Complications. Available at https://www.cdc.gov/nccdphp/publications/factsheets/Prevention/diabetes.htm. Accessed November 8, 2006.
(4) American Diabetes Association. Gestational Diabetes. Available at https://www.diabetes.org/gestational-diabetes.jsp. Accessed November 8, 2006.
(5) "Diabetes in Pregnancy," March of Dimes (2006). https://www.marchofdimes.org/professionals/681_1197.asp
(6) Lanham, MD: "The Diabetes in Pregnancy Dilemma: Leading Change with Proven Solutions, University Press," Journal of the American Medical Association book review (9/27/2006).
(7) "Pregnancy and Diabetes Frequently Asked Questions," Centers for Disease Control (2006).
(8) "Diabetes and Pregnancy Frequently Asked Questions," (2006), Centers for Disease Control.
(10) "High Blood Glucose Levels in Early Pregnancy May Deprive Embryo of Oxygen and Lead to Birth Defects, Joslin Diabetes Center Study Shows," (2005) Joslin Diabetes Center
(11) "Diabetes and Pregnancy," Organization of Teratology Services (2006).
(12) Lanham, MD: "The Diabetes in Pregnancy Dilemma: Leading Change with Proven Solutions, University Press," Journal of the American Medical Association book review (9/27/2006).
Source: Novo Nordisk