The story reports on findings from a clinical trial of Novo Nordisk’s diabetes drug Victoza published in the New England Journal of Medicine. The trial was designed to measure whether Victoza (generic name liraglutide), which is given by injection, was any less likely than standard diabetes care to lead to severe cardiovascular events like heart attacks or strokes in patients with type 2 diabetes. Along with reporting the key outcomes of the trial, the story quotes the lead scientist involved in the study saying that diabetes treatment can begin to move from managing blood sugar levels to managing the disease’s complications.
The importance of finding drugs to manage cardiovascular health in diabetes is made clear, and the story does a good job of contextualizing the significance of the results, comparing Victoza’s performance to rival diabetes drugs and highlighting that the results, although positive, were not as impressive as some pharmaceutical industry observers had hoped.
The story would have been stronger if it had mentioned the costs of Victoza, and included independent expert commentary, especially to contextualize the lead scientist’s claims that drugs like Victoza may herald a “shift” in how diabetes is managed.
Diabetes is one of the most common chronic conditions in the world and its rate is increasing along with higher rates of obesity and an aging population. Treatment of diabetes seeks to modify the risk factors that increase diabetes-associated complications. Though much of the focus of treatment is in lowering blood sugars, decades of evidence suggest that tight sugar control doesn’t decrease important risks such as heart disease, stroke and kidney failure.
For this reason, treatments that not only control blood sugar but also have favorable effects on heart disease have been an area of focus. New classes of medicine such as the GLP-1’s, including Victoza that is studied here, have been evaluated to examine their effect on heart disease and heart disease related death. The favorable results of this study are encouraging and will lead to increased use of these medications.
Though not mentioned in this article, Victoza is given by daily injection under the skin, similar to insulin, and may decrease interest among people seeking the convenience of oral medications. The high cost of the drug and others like it will be another barrier to more widespread use, which argues for additional studies in lower risk groups in whom more established, less costly and easier to take medications are currently recommended.
There is no mention of the costs of Victoza. This would have been easy to include given the drug is widely prescribed and pricing information is freely available on the internet. The article compares the performance of Victoza against rival diabetes drugs, so it would have been informative to have a comparison of costs as well.
The story’s key figure, which features in the headline, is a 13% reduction in the risk of heart attack, stroke and cardiovascular death. Unfortunately this figure only measures the relative risk reduction; i.e. the change in risk for patients who got Victoza as a percentage of the actual risk of heart attacks, strokes or cardiovascular death for patients who didn’t get Victoza.
However, the story does also give actual risk figures for the treatment and placebo group (13.0% vs. 14.9%). This allows a keen eyed reader to calculate the absolute risk reduction: a less impressive sounding 1.9%. Because of this, the story rates Satisfactory on this criterion. It’s worth nothing the news release didn’t include the placebo group reductions.
The story does a good job of mentioning the side effects of Victoza, even pointing towards whether effects were statistically significant. One omission was that the story did not mention the higher incidence of gallstone disease, a side effect that was highlighted as significant in the paper.
Although the strength of the evidence is not directly interrogated, the story provides sufficient details about the study, such as trial size, length of trial, and where it was published.
Type II diabetes is a major public health problem and, as the story mentions, patients frequently die of heart disease. No disease-mongering here.
No third-party scientist is quoted, although the views of one industry analyst are paraphrased. It’s not clear, however, if this analyst was actually interviewed for the story, and his comments pertain only to the market’s expectations for the drug. We didn’t think this was substantive enough to rate as Satisfactory.
The story does mention that Novo Nordisk funded the study and the focus is squarely on the pharmaceutical industry, making the company’s role clear to the reader.
How Victoza performs in reducing severe cardiovascular events compared to rival drugs is mentioned numerous times. It is worth noting that there was no mention that the drug is given by injection. For individuals with diabetes reading the article, this oversight is important in that it may make them more inclined to oral medicines that are easier to take.
The story makes it clear that the drug is already established on the market, calling it “top-selling” in the first line and mentioning that it is typically prescribed as a third or fourth option.
The story makes clear that the purpose of this study was to meet FDA requirements. “Since 2008, U.S. regulators have demanded studies for new diabetes medicines to show there is no increase in heart risk, opening a new battleground between different treatments,” it says.
The story is not based solely on Novo Nordisk’s news release. As mentioned, some of the relative risk figures which the story leans on, as well as two sources who are quoted, are found in the news release. But the writer clearly conducted independent interviews and sourced information elsewhere.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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