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Glucagon

Phase 3FDA approved

Diabetes Mellitus | Small molecule | Metabolic |Eli Lilly and Company|Trials Updated: May 23, 2024

Glucagon development status

FDA approval on record Sep 11, 1998
Approval holderLilly
ApplicationNDA020928
Highest phase Phase 3
Registered trials 20 across 13 sponsors since Jan 2009

Glucagon target and mechanism

Molecular targetGCGR
Target classAgonist
ModalitySmall molecule

Also known as Nasal Glucagon, IM Glucagon, Glucagon Nasal Powder [Baqsimi], Glucagon Nasal Powder, Nasal Glucagon (NG), SC Glucagon, Glucagon for injection (rDNA origin)

Success Probability

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Market & Valuation

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Trial Design

RandomizedACTIVE_CONTROLLED
Total Trials11
Total Enrollment593

FDA Designations

No designations recorded

Glucagon clinical trials

Glucagon · 11 trials · 7 indications

Phase 3 5Phase 2 2Phase 1 4
NCT03421379A Study of Nasal Glucagon (LY900018) in Japanese Participants With Diabetes MellitusDiabetes Mellitus
COMPLETED75 Analytics
NCT02402933Clinical Usability of Nasal Glucagon in Treatment of Hypoglycemia in Children and AdolescentsHypoglycemia
COMPLETED26 Analytics
NCT02171130Clinical Usability of Intranasal Glucagon in Treatment of HypoglycemiaHypoglycemia
COMPLETED129 Analytics
NCT01994746Efficacy and Safety of Nasal Glucagon for Treatment of Hypoglycemia in AdultsDiabetes Mellitus, Type 1
COMPLETED77 Analytics
NCT01959334Evaluate the Immunogenicity of a Novel Glucagon FormulationDrug-specific Antibodies
COMPLETED75 Analytics
PHASE3COMPLETED
A Study of Nasal Glucagon (LY900018) in Japanese Participants With Diabetes Mellitus
Diabetes MellitusUnlock trial analytics
PHASE3COMPLETED
Clinical Usability of Nasal Glucagon in Treatment of Hypoglycemia in Children and Adolescents
HypoglycemiaUnlock trial analytics
PHASE3COMPLETED
Clinical Usability of Intranasal Glucagon in Treatment of Hypoglycemia
HypoglycemiaUnlock trial analytics
PHASE3COMPLETED
Efficacy and Safety of Nasal Glucagon for Treatment of Hypoglycemia in Adults
Diabetes Mellitus, Type 1Unlock trial analytics
PHASE3COMPLETED
Evaluate the Immunogenicity of a Novel Glucagon Formulation
Drug-specific AntibodiesUnlock trial analytics

Study Endpoints

Primary Endpoints

Percentage of Participants Achieving Treatment Success During Controlled Insulin-Induced Hypoglycemia
Pre-dose up to 30 minutes post each glucagon administration

Percentage of participants who achieved treatment success during the controlled insulin-induced hypoglycemia in participants with type 1 diabetes mellitus (T1DM) and participants with type 2 diabetes mellitus (T2DM).Treatment success is defined as an increase in plasma glucose to greater than or equal to (≥) 70 milligrams per deciliter (mg/dL) or an increase of ≥20 mg/dL from plasma glucose nadir, without receiving additional actions to increase the plasma glucose concentration. Nadir is defined as the minimum plasma glucose concentration at the time of or within 10 minutes following glucagon administration.

Number of Participants Awakening or Returning to a Normal Status Within 30 Minutes Following Studied Drug of Administration
Within 30 minutes after each drug administration for an episode of hypoglycemia

Responses to questions completed by the caregiver are used to assess this outcome. An episode of severe hypoglycemia is generally defined as an event associated with severe neuroglycopenia usually resulting in coma or seizure and requiring parenteral therapy (glucagon or intravenous glucose) administered by a third party. In this study moderate hypoglycemia is defined as an episode wherein the child/adolescent with diabetes has symptoms and/or signs of neuroglycopenia and has a blood glucose ≤3.9 millimoles per liter (mmol/L) (70 milligram per deciliter \[mg/dL\]) based on a blood sample taken at or close to the time of treatment.

Percentage of Participants Awakening or Returning to a Normal Status Within 30 Minutes Following Studied Drug of Administration
Within 30 minutes after each drug administration for an episode of hypoglycemia

Responses to questions completed by the caregiver were used to assess this outcome. An episode of severe hypoglycemia was defined as an episode wherein the person with diabetes is clinically incapacitated to the point where the person requires third-party assistance to treat the hypoglycemia. An episode of moderate hypoglycemia episode was defined as an episode wherein the person with diabetes was showing signs of neuroglycopenia and had a glucometer reading of approximately 60 milligrams per deciliter (mg/dL) (3.3 millimoles per liter \[mmol/L\]) or less based on a blood sample taken at or near the time of treatment.

Increase in Plasma Glucose Level to >=70mg/dL or an Increase of >=20mg/dL From Glucose Nadir
Within 30 minutes after receiving glucagon at both dosing visits (glucose was measured at pre-dose; 5, 10, 15, 20, 25, and 30 minutes following glucagon administration)

Increase in blood glucose to ≥70 mg/dL or an increase of ≥20 mg/dL from glucose nadir within 30 minutes after receiving study glucagon, without receiving additional actions to increase the blood glucose level defines treatment success. Due to the residual activity of circulating insulin, glucose nadir was defined as the minimum glucose measurement at the time of, or within 10 minutes following glucagon administration.

Percentage of Participants With Treatment-emergent Anti-Drug Antibody (ADA)
Baseline through study completion (up to 10 weeks)

Glucagon anti-drug antibodies (ADA) were assessed at baseline through study completion. Percentage of participants (Pts) with ADA=(number of Pts with treatment-emergent ADA/number of Pts assessed)\*100. Treatment-Emergent ADA includes treatment-induced ADA and treatment boosted ADA. Treatment-induced is defined as participants with 'Not Detected' ADA at baseline (drug-naive) and at least one post-baseline ADA 'Detected' sample with a corresponding titer that is one 2-fold dilution higher than the MRD (minimal required dilution) of the assay. For the nasal glucagon Tier 1-3 ADA screening assay, the MRD is 1:20. Treatment-boosted is defined as Patient with ADA 'Detected' at baseline (drug-naive) and at least one post-baseline ADA 'Detected' sample with a corresponding titer that is at least (\>or=) 4-fold higher than the baseline titer.

Percentage of Participants With Neutralizing Antibodies
Baseline through study completion (up to 10 weeks)
Number of Participants With At Least One Adverse Event
First dose of study drug through the post-study completion (up to 10 weeks)

Safety parameters assessed included the occurrence of adverse events, the measurement of clinical laboratory parameters; vital signs, ECGs, physical examination, blood glucose, and examination of the injection site (following the IM administration). An AE was defined as any untoward medical occurrence in a clinical investigation subject administered the investigational product and which did not necessarily have a causal relationship with this treatment A summary of other nonserious AEs, and all SAE's, regardless of causality, is located in the Reported Adverse Events section.

Maximum Change From Baseline Concentration (Cmax) of Glucagon
Pre-dose; 5, 10, 15, 20, 30, 40, 60 and 90 minutes following glucagon administration
Time to Maximum Concentration (Tmax) of Baseline Adjusted Glucagon
Pre-dose; 5, 10, 15, 20, 30, 40, 60 and 90 minutes following glucagon administration
Area Under the Curve (AUC0-1.5) of Baseline Adjusted Glucagon
Pre-dose; 5, 10, 15, 20, 30, 40, 60 and 90 minutes following glucagon administration
Maximum Concentration (Cmax) of Baseline-Adjusted Glucose
Pre-dose; 5, 10, 15, 20, 30, 40, 60 and 90 minutes following glucagon administration
Time to Maximum Concentration (Tmax) of Baseline-Adjusted Glucose
Pre-dose; 5, 10, 15, 20, 30, 40, 60 and 90 minutes following glucagon administration
Area Under the Effect Concentration Time Curve (AUEC0-1.5) of Baseline-Adjusted Glucose From Time Zero up to 90 Minutes
Pre-dose; 5, 10, 15, 20, 30, 40, 60 and 90 minutes following glucagon administration
Percentage of Responders
Pre-dose; 30 minutes following glucagon administration

Participants with a blood glucose increment of ≥1.5 millimole per liter \[mmol/L) within 15 of nadir (5 minutes post dose) and for at least 10 minutes following nadir.

Number of Participants With One or More Treatment-Emergent Adverse Event(s) (TEAEs) and Serious Adverse Event(s) (SAEs) Considered by the Investigator to be Related to Study Drug Administration
Baseline to Day 9

A TEAE is defined as an adverse event which occurs post-dose or which is present prior to dosing and becomes more severe post-dose. An SAE is any AE from the study that results in 1 of the following: Death, initial or prolonged inpatient hospitalization, a life-threatening experience (i.e., immediate risk of dying), persistent or significant disability/incapacity, congenital anomaly/birth defect, important medical events that may not be immediately life-threatening or result in death or hospitalization but may jeopardize the subject or may require intervention to prevent 1 of the other outcomes listed in the definition above. The number of participants with one or more TEAEs, SAEs considered by the investigator to be related to study drug administration is reported here. A summary of SAEs and other non-serious AEs, regardless of causality is located in the Reported Adverse Events section of this record.

Pharmacokinetics (PK): Area Under the Concentration Versus Time Curve From Time Zero to T(AUC[0-tlast]) of Baseline-Adjusted Glucagon
-0.5, -0.25, 0.00, 0.08, 0.17, 0.33, 0.50, 0.75, 1.00, 1.25, 1.50, 1.75, 2.00, 2.50, 3.00 hours after glucagon administration
PK: Time to Maximum Concentration (Tmax) of Baseline Adjusted Glucagon
-0.5, -0.25, 0.00, 0.08, 0.17, 0.33, 0.50, 0.75, 1.00, 1.25, 1.50, 1.75, 2.00, 2.50, 3.00 hours after glucagon administration
PK: Maximum Change From Baseline Concentration (Cmax) of Glucagon
-0.5, -0.25, 0.00, 0.08, 0.17, 0.33, 0.50, 0.75, 1.00, 1.25, 1.50, 1.75, 2.00, 2.50, 3.00 hours after glucagon administration
Pharmacodynamics (PD): Area Under the Effect Concentration Time Curve (AUEC0-3) of Baseline-Adjusted Glucose From Time Zero up to 3 Hours
-0.5, -0.25, 0.00, 0.08, 0.17, 0.33, 0.50, 0.75, 1.00, 1.25, 1.50, 1.75, 2.00, 2.50, 3.00 hours after glucagon administration
PD: Time to Maximum Concentration (Tmax) of Baseline-Adjusted Glucose
-0.5, -0.25, 0.00, 0.08, 0.17, 0.33, 0.50, 0.75, 1.00, 1.25, 1.50, 1.75, 2.00, 2.50, 3.00 hours after glucagon administration
PD: Baseline-Adjusted Glucose Maximum Concentration (BGmax)
-0.5, -0.25, 0.00, 0.08, 0.17, 0.33, 0.50, 0.75, 1.00, 1.25, 1.50, 1.75, 2.00, 2.50, 3.00 hours after glucagon administration
Number of Participants With One or More Serious Adverse Event(s) (SAEs)
Baseline up to Study Completion (Day 30)

Safety and tolerability evaluated through the assessment of adverse events. A SAE (serious adverse event) was defined as any untoward medical occurrence in a clinical investigation participant administered the investigational product and which did not necessarily have a causal relationship with this treatment. A summary of other non-serious AEs, and all SAE's, regardless of causality, is located in the Reported Adverse Events section.

Secondary Endpoints

Pharmacodynamics (PD): Change From Baseline in Maximal Blood Glucose (BGmax) of Glucagon Nasal Powder and Glucagon Hydrochloride Intramuscular (IM)
Pre-dose, 5, 10, 15, 20, 25, 30, 40, 50, 60, 90, 120, 240 minutes after each glucagon administration
PD: Time to Maximal Concentration (Tmax) of Glucagon Nasal Powder and Glucagon Hydrochloride IM
Pre-dose, 5, 10, 15, 20, 25, 30, 40, 50, 60, 90, 120, 240 minutes after each glucagon administration
Pharmacokinetics (PK): Change From Baseline in Area Under the Concentration Versus Time Curve From Zero to Time t (AUC [0-tLast]) of Glucagon Nasal Powder and Glucagon Hydrochloride IM
Pre-dose, 5, 10, 15, 20, 25, 30, 40, 50, 60, 90, 120, 240 minutes after each glucagon administration
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Study Design & Arms

AllocationRANDOMIZED
MaskingNONE
ModelCROSSOVER
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
Glucagon Nasal PowderEXPERIMENTALA single dose of 3 milligram (mg) glucagon nasal powder administered intranasally.
Glucagon Hydrochloride SolutionACTIVE_COMPARATORA single dose of 1 mg glucagon hydrochloride solution was administered intramuscular (IM)
Nasal GlucagonEXPERIMENTALA single dose of 3mg glucagon nasal powder administered using a nasal powder delivery device for the treatment of moderate or severe hypoglycemic events; a maximum of 4 events per participant during the study.
Intramuscular GlucagonACTIVE_COMPARATORAt a separate visit, 1 mg of glucagon was administered into the deltoid muscle of the non-dominant arm (intramuscular \[IM\]).
Glucagon IMACTIVE_COMPARATORGlucagon dose of 1 milligram (mg) administered intramuscularly (IM).
Nasal Glucagon (NGEXPERIMENTALNasal Glucagon (NG) doses of 3 mg administered intra-nasally.
Nasal Glucagon (NG)EXPERIMENTALNasal glucagon (NG) doses of 2.0 mg and 3.0 mg for participants 4 to less than 12 years of age and 3.0 mg for those 12 to less than 17 years of age were administered in a nostril with a prefilled delivery device that delivered a single dose upon activation.
Intramuscular (IM) GlucagonACTIVE_COMPARATORParticipants who weighed at least 25 kilograms (kg)/55 pounds (lbs) were dosed 1 mg of IM glucagon; participants who weighed less than 25 kg/55 lbs, IM glucagon dosed with 0.5 mg
Nasal Glucagon 1 mgEXPERIMENTALNasal glucagon (NG) administered as single dose of 1 milligram (mg).
Nasal Glucagon 2 mgEXPERIMENTALNG administered as single dose of 2 mg.
SC GlucagonACTIVE_COMPARATORGlucagon solution dose of 1 mg administered as a single subcutaneous (SC) injection.
Nasal Glucagon 3 mgEXPERIMENTALNG administered as single dose of 3 mg (composed of one dose of 1 mg NG immediately followed by one dose of 2mg NG).
3 milligram (mg) Nasal GlucagonEXPERIMENTALParticipants received a single dose of 3 mg glucagon powder administered intranasally on day 1.
Nasal Glucagon (NG) - Treatment 1EXPERIMENTALOne dose of 3 milligram (mg) NG administered in one of four study periods.
NG - Treatment 2EXPERIMENTALTwo NG doses, 3 mg each dose, administered 15 minutes apart, in the same nostril, in one of four study periods.
NG - Treatment 3EXPERIMENTALTwo NG doses, 3 mg each dose, administered 15 minutes apart, in opposite nostrils, in one of four study periods.
NG - Treatment 4EXPERIMENTALTwo NG doses, 3 mg each dose, administered one immediately after the other, in opposite nostrils, in one of four study periods.
Nasal Glucagon (NG) - Common ColdEXPERIMENTALCohort 1 - Nasal Glucagon (NG) administered once in participants with a common cold.
Nasal Glucagon (NG) - Symptom-FreeEXPERIMENTALCohort 1 - NG administered once in participants who have recovered from a common cold.
NG - Common Cold+OxymetazolineEXPERIMENTALCohort 2 - NG administered once in participants with a common cold who are taking oxymetazoline.

Interventions

NameTypeDescription
Glucagon Nasal PowderDRUGAdministered intranasally
Glucagon Hydrochloride SolutionDRUGAdministered IM
Nasal GlucagonDRUG3 mg nasal glucagon powder
Intramuscular GlucagonDRUG -
Nasal Glucagon (NG)DRUG -
Glucagon IMDRUG -
Nasal Glucagon 1 mgDRUG -
Nasal Glucagon 2 mgDRUG -
SC GlucagonDRUG -
Nasal Glucagon 3 mgDRUG -
Glucagon Nasal Powder [Baqsimi]DRUGAdministered intranasally
OxymetazolineDRUGAdministered intranasally.
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Eligibility Criteria

Age Range18 Years to 70 Years
SexALL
Healthy VolunteersNo
Study Sites4

Inclusion Criteria: * Participants with Type 1 diabetes (T1D) or Type 2 diabetes (T2D) * Body mass Index (BMI) of 18.5 to 30.0 kilograms per meter squared (kg/m2) for T1D, or 18.5 to 35.0 kg/m2 for T2D * Hemoglobin A1c (HbA1c) ≤10% Exclusion Criteria: * Have significant changes in insulin regimen...

Countries:JapanUnited StatesCanadaGermany
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Frequently asked questions about Glucagon

What is Glucagon used for?

Glucagon is used for hypoglycemia and diabetes mellitus, including type 1 diabetes. It is also studied in conditions such as drug-specific antibodies and the common cold. The listed indications cover hypoglycemia, type 1 diabetes, diabetes mellitus, drug-specific antibodies, and the common cold.

What does Glucagon target?

Glucagon targets GCGR, the glucagon receptor, and acts as an agonist. By activating this receptor, the drug stimulates glucagon signaling. This mechanism underlies its use in hypoglycemia and diabetes-related settings. GCGR agonism is the defined molecular target for this small molecule.

Who makes Glucagon?

Glucagon is developed by Eli Lilly and Company, which trades under the ticker LLY. The company is listed as the developer of the nasal glucagon program, including the formulation referenced as LY900018 in its clinical studies.

What phase is Glucagon in?

Glucagon is in Phase 1 development. It is investigational and is not described as approved. The program includes four completed clinical trials, with no active trials currently listed. Reported trial phases include Phase 1 and one Phase 3 study.

What clinical trials is Glucagon in?

Glucagon has been studied in four completed trials: NCT04992312 in pediatric type 1 diabetes, NCT03421379 in Japanese participants with diabetes mellitus, NCT03339453 in type 1 diabetes and hypoglycemia, and NCT02806973 in type 1 and type 2 diabetes. Total enrollment across these trials was 243 participants.

Is Glucagon the same as Nasal Glucagon or Baqsimi?

Glucagon is also known as Nasal Glucagon, IM Glucagon, Glucagon Nasal Powder, Nasal Glucagon 1 mg, and Nasal Glucagon (NG). The nasal powder form is referenced as Baqsimi. These names refer to the same glucagon program and its nasal and injectable formulations.