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Efficacy and Safety Study of Saxagliptin + Metformin Immediate Release (IR) Versus Metformin IR Alone in Type 2 Diabetes Mellitus

A Multicenter, Randomized, Double-Blind, Placebo-Controlled, Parallel-Group, Phase 3 Trial to Evaluate the Efficacy and Safety of 2.5 mg Saxagliptin, Twice Daily, in Combination With Metformin IR in Subjects With Type 2 Diabetes Mellitus Who Have Inadequate Glycemic Control on Metformin IR Alone

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00885378
Enrollment
166
Registered
2009-04-22
Start date
2009-05-31
Completion date
2010-02-28
Last updated
2015-06-01

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Type 2 Diabetes Mellitus

Brief summary

The purpose of this study is to compare the reduction in hemoglobin A1C (A1C) for participants taking saxagliptin in combination with metformin immediate release (IR) versus metformin IR alone.

Interventions

DRUGSaxagliptin plus metformin IR

Tablets, Oral, 2.5 mg, Twice daily, 12 weeks

DRUGPlacebo plus metformin IR

Tablets, Oral, Placebo, Twice daily, 12 weeks

Sponsors

AstraZeneca
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
18 Years to 78 Years
Healthy volunteers
No

Inclusion criteria

* Type 2 diabetes * 18-78 years of age * Taking stable twice daily (BID) dosing of metformin IR (at least 1500 mg) for at least 8 weeks * A1C: 7-10% * C-peptide: ≥ 0.8 ng/mL * Body mass index (BMI): ≤45 kg/m\^2

Exclusion criteria

* Women of childbearing potential unable or unwilling to use acceptable birth control * Women who are pregnant or breastfeeding * Fasting plasma glucose (FPG) \>270 mg/dL * Significant cardiovascular history * Symptoms of poorly controlled diabetes * History of diabetic ketoacidosis or hyperosmolar nonketotic coma * Insulin therapy within one year of screening * Cardiovascular even within the prior 6 months * New York Heart Association Stage III/IV congestive heart failure and/or known left ventricular ejection fraction \<=40% * Significant history of renal or hepatic disease * History of a psychiatric disorder, alcohol or drug abuse within the previous year * Treatment with potent CYP3A4 inhibitors or inducers * Immunocompromised participants * Active liver disease or clinically significant abnormal hepatic, renal , endocrine, metabolic, or hematological screening tests

Design outcomes

Primary

MeasureTime frameDescription
Mean Hemoglobin A1C (A1c) and Change From Baseline to Week 12Baseline, Week 12Mean change was adjusted for baseline.

Secondary

MeasureTime frameDescription
Mean Baseline and Change From Baseline in Fasting Plasma Glucose (FPG)Baseline, Week 12Mean change was adjusted for baseline.
Percentage of Participants Achieving a Therapeutic Glycemic Response (A1C < 7.0%) at Week 12Week 12Adjusted for baseline. Calculated using the method by Zhang et al. (Zhang M, Tsiatis A, Davidian M. Improving efficiency of inference in randomized clinical trials using auxiliary covariates. Biometrics. Published online on January 11, 2008; Digital Object Identifier: 10.1111/j.1541-0420.2007.00976.x.)
Percentage of Participants Achieving a Therapeutic Glycemic Response (A1C <= 6.5%) at Week 12Week 12Adjusted for baseline. Calculated using the method by Zhang et al. (Zhang M, Tsiatis A, Davidian M. Improving efficiency of inference in randomized clinical trials using auxiliary covariates. Biometrics. Published online on January 11, 2008; Digital Object Identifier: 10.1111/j.1541-0420.2007.00976.x.)

Other

MeasureTime frameDescription
Baseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)Baseline, Week 4, Week 8, Week 12Baseline values reference the measurement for the cohort of participants evaluated at the given time point.
Baseline and Mean Change From Baseline in Participant Heart Rate (HR)Baseline, Week 4, Week 8, Week 12Baseline values reference the measurement for the cohort of participants evaluated at the given time point.
Participant Adverse Event (AE), Related AE, Serious Adverse Event (SAE), Related SAE, and Discontinued Due to AEs SummaryWeek 1 to Week 12; AEs are included up to the last treatment day + 1 day or the last visit in the double-blind (DB) period. SAEs are included up to the last of 1) the last treatment day + 30 days or 2) the last visit day + 30 days in the DB period.AE = any new untoward medical occurrence/worsening of a pre-existing medical condition which does not necessarily have a causal relationship with this treatment.SAE = any untoward medical occurrence that at any dose: results in death, is life-threatening, requires inpatient hospitalization or causes prolongation of existing hospitalization, results in persistent or significant disability/incapacity, is a congenital anomaly/birth defect, results in development of drug dependency or drug abuse, is an important medical event. Treatment-related=Possible, Probable, or Certain relationship to drug.
Participants Experiencing Changes From Baseline in Urinalysis Parameters That Met the Marked Abnormality CriteriaBaseline, Week 12Marked abnormality criteria were urine protein: if pre-Rx=o use \>=2, if pre-Rx =0.5 or 1 use \>=3, if pre-Rx =2, use \>=4; urine blood: if pre-Rx=0, use \>=2, if pre-Rx=0.5 or 1, use \>=3, if pre-Rx=2, use \>=4; Urine red blood cell count (RBC): if pre-Rx=o use \>=2, if pre-Rx =0.5 or 1 use \>=3, if pre-Rx =2, use \>=4; urine white blood cell count (WBC): if pre-Rx=o use \>=2, if pre-Rx =0.5 or 1 use \>=3, if pre-Rx =2, use \>=4.
Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaBaseline, Week 12A laboratory value was considered a marked abnormality if it is outside the pre-defined criteria for marked abnormality and the on-treatment value was more extreme (farther from the limit) than the baseline value. ULN=upper limit of normal; LLN=lower limit of normal.
Participants With Reported Hypoglycemia AEs During Double-Blind Treatment PeriodWeek 1 to Week 12; AEs are included up to the last treatment day + 1 day or the last visit in the DB period. SAEs are included up to the last of 1) the last treatment day + 30 days or 2) the last visit day + 30 days in the DB period.Hypoglycemic Events are based upon the Saxagliptin Predefined List of Events, which included hypoglycemia, blood glucose decreased, and hypoglycemic unconsciousness.
Participants With Confirmed HypoglycemiaWeek 1 to Week 12; AEs are included up to the last treatment day + 1 day or the last visit in the DB period. SAEs are included up to the last of 1) the last treatment day + 30 days or 2) the last visit day + 30 days in the DB period.Confirmed hypoglycemia was defined by a fingerstick glucose value \<= 50 mg/dL with associated hypoglycemia symptoms.
Participant Electrocardiogram (ECG) Status at Baseline and Week 12Baseline, Week 12Abnormal ECGs were defined as those not within the normal limits for the participant, according to the investigator. 'Shifted Normal to Abnormal' and 'Shifted Abnormal to Normal' references a change from measurements at Baseline to those at Week 12.

Countries

Germany, Hungary, Puerto Rico, United States

Participant flow

Recruitment details

Participants at 43 sites in 4 countries (25 sites in the United States \[US\], 9 in Germany, 5 in Hungary, and 4 in Puerto Rico) received study medication and participated in this study.

Pre-assignment details

Of the 166 subjects who entered the lead-in period, 6 discontinued: 3 withdrawal of consent, 1 poor/noncompliance, 1 adverse event (AE; abdominal pain secondary to partial small bowel obstruction), and 1 elevated liver enzymes that did not meet study exclusion criteria but was discontinued by the investigator.

Participants by arm

ArmCount
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)
Saxagliptin 2.5 mg tablets orally (PO) plus a flexible metformin IR dose twice daily (BID).
74
Placebo + Metformin IR
2.5 mg placebo tablets PO BID plus flexible metformin IR dose.
86
Total160

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyLack of Efficacy22
Overall StudyLost to Follow-up12
Overall StudyPoor/Noncompliance22
Overall StudyProtocol Violation20
Overall StudyWithdrawal by Subject12

Baseline characteristics

CharacteristicSaxagliptin 2.5 mg + Metformin Immediate Release (IR)TotalPlacebo + Metformin IR
Age, Continuous53.90 years
STANDARD_DEVIATION 10.35
55.4 years
STANDARD_DEVIATION 10.2
56.60 years
STANDARD_DEVIATION 9.97
Mean Body Mass Index (BMI)33.68 kg / m^2
STANDARD_DEVIATION 5.94
33.05 kg / m^2
STANDARD_DEVIATION 6.08
32.51 kg / m^2
STANDARD_DEVIATION 6.18
Mean Duration of Type 2 Diabetes Mellitus5.81 Years
STANDARD_DEVIATION 6.37
6.00 Years
STANDARD_DEVIATION 5.3
6.17 Years
STANDARD_DEVIATION 4.21
Mean Height168.38 cm
STANDARD_DEVIATION 9.56
168.05 cm
STANDARD_DEVIATION 9.23
167.77 cm
STANDARD_DEVIATION 8.99
Mean Metformin Dose at Baseline1911.5 mg
STANDARD_DEVIATION 376.59
1881.6 mg
STANDARD_DEVIATION 352.38
1855.8 mg
STANDARD_DEVIATION 330.19
Mean Weight95.85 kg
STANDARD_DEVIATION 21.4
93.64 kg
STANDARD_DEVIATION 20.63
91.74 kg
STANDARD_DEVIATION 19.87
Participant Body Mass Index
< 30 kg / m^2
19 Participants54 Participants35 Participants
Participant Body Mass Index
>= 30 kg / m^2
55 Participants106 Participants51 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants1 Participants1 Participants
Race (NIH/OMB)
Asian
2 Participants4 Participants2 Participants
Race (NIH/OMB)
Black or African American
8 Participants11 Participants3 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
White
64 Participants144 Participants80 Participants
Region of Enrollment
Germany
9 participants21 participants12 participants
Region of Enrollment
Hungary
8 participants16 participants8 participants
Region of Enrollment
Puerto Rico
8 participants18 participants10 participants
Region of Enrollment
United States
49 participants105 participants56 participants
Sex: Female, Male
Female
34 Participants75 Participants41 Participants
Sex: Female, Male
Male
40 Participants85 Participants45 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
0 / 860 / 74
serious
Total, serious adverse events
1 / 861 / 74

Outcome results

Primary

Mean Hemoglobin A1C (A1c) and Change From Baseline to Week 12

Mean change was adjusted for baseline.

Time frame: Baseline, Week 12

Population: Randomized participants with both a baseline value and post-baseline value (up to Week 12).

ArmMeasureGroupValue (MEAN)Dispersion
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Mean Hemoglobin A1C (A1c) and Change From Baseline to Week 12Baseline7.92 Percentage of glycosylated hemoglobinsStandard Error 0.11
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Mean Hemoglobin A1C (A1c) and Change From Baseline to Week 12Adjusted Mean Change From Baseline-0.56 Percentage of glycosylated hemoglobinsStandard Error 0.09
Placebo + Metformin IRMean Hemoglobin A1C (A1c) and Change From Baseline to Week 12Baseline7.97 Percentage of glycosylated hemoglobinsStandard Error 0.09
Placebo + Metformin IRMean Hemoglobin A1C (A1c) and Change From Baseline to Week 12Adjusted Mean Change From Baseline-0.22 Percentage of glycosylated hemoglobinsStandard Error 0.08
p-value: 0.006395% CI: [-0.58, -0.1]ANCOVA
Secondary

Mean Baseline and Change From Baseline in Fasting Plasma Glucose (FPG)

Mean change was adjusted for baseline.

Time frame: Baseline, Week 12

Population: Randomized participants with a measurement at the specified timepoint with Last Observation Carried Forward (LOCF).

ArmMeasureGroupValue (MEAN)Dispersion
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Mean Baseline and Change From Baseline in Fasting Plasma Glucose (FPG)Mean Baseline164.22 mg / dLStandard Error 5.512
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Mean Baseline and Change From Baseline in Fasting Plasma Glucose (FPG)Adjusted Mean Change from Baseline-13.73 mg / dLStandard Error 4.51
Placebo + Metformin IRMean Baseline and Change From Baseline in Fasting Plasma Glucose (FPG)Adjusted Mean Change from Baseline-4.22 mg / dLStandard Error 4.2
Placebo + Metformin IRMean Baseline and Change From Baseline in Fasting Plasma Glucose (FPG)Mean Baseline161.25 mg / dLStandard Error 4.624
p-value: 0.124895% CI: [-21.68, 2.66]ANCOVA
Secondary

Percentage of Participants Achieving a Therapeutic Glycemic Response (A1C <= 6.5%) at Week 12

Adjusted for baseline. Calculated using the method by Zhang et al. (Zhang M, Tsiatis A, Davidian M. Improving efficiency of inference in randomized clinical trials using auxiliary covariates. Biometrics. Published online on January 11, 2008; Digital Object Identifier: 10.1111/j.1541-0420.2007.00976.x.)

Time frame: Week 12

Population: Randomized participants with measurement at timepoint with LOCF.

ArmMeasureValue (NUMBER)
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Percentage of Participants Achieving a Therapeutic Glycemic Response (A1C <= 6.5%) at Week 1224.6 Percentage of Participants
Placebo + Metformin IRPercentage of Participants Achieving a Therapeutic Glycemic Response (A1C <= 6.5%) at Week 1210.7 Percentage of Participants
95% CI: [3, 24.7]
Secondary

Percentage of Participants Achieving a Therapeutic Glycemic Response (A1C < 7.0%) at Week 12

Adjusted for baseline. Calculated using the method by Zhang et al. (Zhang M, Tsiatis A, Davidian M. Improving efficiency of inference in randomized clinical trials using auxiliary covariates. Biometrics. Published online on January 11, 2008; Digital Object Identifier: 10.1111/j.1541-0420.2007.00976.x.)

Time frame: Week 12

Population: Randomized participants with measurement at timepoint with LOCF.

ArmMeasureValue (NUMBER)
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Percentage of Participants Achieving a Therapeutic Glycemic Response (A1C < 7.0%) at Week 1237.5 Percentage of Participants
Placebo + Metformin IRPercentage of Participants Achieving a Therapeutic Glycemic Response (A1C < 7.0%) at Week 1224.2 Percentage of Participants
95% CI: [1.1, 25.4]
Other Pre-specified

Baseline and Mean Change From Baseline in Participant Heart Rate (HR)

Baseline values reference the measurement for the cohort of participants evaluated at the given time point.

Time frame: Baseline, Week 4, Week 8, Week 12

Population: All treated participants. n= number of participants with measurement at time point.

ArmMeasureGroupValue (MEAN)Dispersion
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Baseline and Mean Change From Baseline in Participant Heart Rate (HR)Baseline HR for Week 4 cohort (n=74, 84)73.45 mm HgStandard Error 1.072
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Baseline and Mean Change From Baseline in Participant Heart Rate (HR)HR Change From Baseline at Week 4 (n=74, 84)0.97 mm HgStandard Error 0.881
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Baseline and Mean Change From Baseline in Participant Heart Rate (HR)Baseline HR for Week 8 cohort (n=70, 81)73.51 mm HgStandard Error 1.091
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Baseline and Mean Change From Baseline in Participant Heart Rate (HR)HR Change From Baseline at Week 8 (n=70, 81)2.70 mm HgStandard Error 0.914
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Baseline and Mean Change From Baseline in Participant Heart Rate (HR)Baseline HR for Week 12 cohort (n=66, 77)73.71 mm HgStandard Error 1.142
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Baseline and Mean Change From Baseline in Participant Heart Rate (HR)HR Change From Baseline at Week 12 (n=66, 77)0.61 mm HgStandard Error 1.061
Placebo + Metformin IRBaseline and Mean Change From Baseline in Participant Heart Rate (HR)Baseline HR for Week 12 cohort (n=66, 77)73.55 mm HgStandard Error 1.035
Placebo + Metformin IRBaseline and Mean Change From Baseline in Participant Heart Rate (HR)Baseline HR for Week 4 cohort (n=74, 84)73.77 mm HgStandard Error 0.968
Placebo + Metformin IRBaseline and Mean Change From Baseline in Participant Heart Rate (HR)HR Change From Baseline at Week 8 (n=70, 81)0.28 mm HgStandard Error 0.727
Placebo + Metformin IRBaseline and Mean Change From Baseline in Participant Heart Rate (HR)HR Change From Baseline at Week 4 (n=74, 84)1.18 mm HgStandard Error 0.778
Placebo + Metformin IRBaseline and Mean Change From Baseline in Participant Heart Rate (HR)HR Change From Baseline at Week 12 (n=66, 77)0.60 mm HgStandard Error 0.866
Placebo + Metformin IRBaseline and Mean Change From Baseline in Participant Heart Rate (HR)Baseline HR for Week 8 cohort (n=70, 81)73.56 mm HgStandard Error 0.99
Other Pre-specified

Baseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)

Baseline values reference the measurement for the cohort of participants evaluated at the given time point.

Time frame: Baseline, Week 4, Week 8, Week 12

Population: All treated participants. n= number of participants with measurement at time point.

ArmMeasureGroupValue (MEAN)Dispersion
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Baseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)Baseline SBP for Week 4 cohort (n=74, 84)128.89 mm HgStandard Error 1.67
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Baseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)Baseline DBP for Week 4 cohort (n=74, 84)78.99 mm HgStandard Error 1.07
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Baseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)SBP Change From Baseline at Week 4 (n=74, 84)-0.47 mm HgStandard Error 1.43
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Baseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)DBP Change From Baseline at Week 4 (n=74, 84)-0.81 mm HgStandard Error 0.84
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Baseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)Baseline SBP for Week 8 cohort (n=70, 81)128.33 mm HgStandard Error 1.67
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Baseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)Baseline DBP for Week 8 cohort (n=70, 81)78.87 mm HgStandard Error 1.08
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Baseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)SBP Change From Baseline at Week 8 (n=70, 81)0.60 mm HgStandard Error 1.66
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Baseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)DBP Change From Baseline at Week 8 (n=70, 81)0.37 mm HgStandard Error 0.94
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Baseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)Baseline SBP for Week 12 cohort (n=66, 77)128.18 mm HgStandard Error 1.76
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Baseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)Baseline DBP for Week 12 cohort (n=66, 77)78.85 mm HgStandard Error 1.13
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Baseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)SBP Change From Baseline at Week 12 (n=66, 77)1.59 mm HgStandard Error 1.51
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Baseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)DBP Change From Baseline at Week 12 (n=66, 77)1.03 mm HgStandard Error 0.75
Placebo + Metformin IRBaseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)SBP Change From Baseline at Week 12 (n=66, 77)0.83 mm HgStandard Error 1.26
Placebo + Metformin IRBaseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)Baseline SBP for Week 4 cohort (n=74, 84)127.57 mm HgStandard Error 1.53
Placebo + Metformin IRBaseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)SBP Change From Baseline at Week 8 (n=70, 81)-0.43 mm HgStandard Error 1.48
Placebo + Metformin IRBaseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)Baseline DBP for Week 4 cohort (n=74, 84)77.07 mm HgStandard Error 1.05
Placebo + Metformin IRBaseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)Baseline DBP for Week 12 cohort (n=66, 77)77.23 mm HgStandard Error 1.06
Placebo + Metformin IRBaseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)SBP Change From Baseline at Week 4 (n=74, 84)0.17 mm HgStandard Error 1.16
Placebo + Metformin IRBaseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)DBP Change From Baseline at Week 8 (n=70, 81)0.86 mm HgStandard Error 0.93
Placebo + Metformin IRBaseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)DBP Change From Baseline at Week 4 (n=74, 84)0.95 mm HgStandard Error 0.86
Placebo + Metformin IRBaseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)DBP Change From Baseline at Week 12 (n=66, 77)1.29 mm HgStandard Error 0.85
Placebo + Metformin IRBaseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)Baseline SBP for Week 8 cohort (n=70, 81)127.60 mm HgStandard Error 1.57
Placebo + Metformin IRBaseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)Baseline SBP for Week 12 cohort (n=66, 77)127.38 mm HgStandard Error 1.56
Placebo + Metformin IRBaseline and Mean Change From Baseline in Participant Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP)Baseline DBP for Week 8 cohort (n=70, 81)77.32 mm HgStandard Error 1.03
Other Pre-specified

Participant Adverse Event (AE), Related AE, Serious Adverse Event (SAE), Related SAE, and Discontinued Due to AEs Summary

AE = any new untoward medical occurrence/worsening of a pre-existing medical condition which does not necessarily have a causal relationship with this treatment.SAE = any untoward medical occurrence that at any dose: results in death, is life-threatening, requires inpatient hospitalization or causes prolongation of existing hospitalization, results in persistent or significant disability/incapacity, is a congenital anomaly/birth defect, results in development of drug dependency or drug abuse, is an important medical event. Treatment-related=Possible, Probable, or Certain relationship to drug.

Time frame: Week 1 to Week 12; AEs are included up to the last treatment day + 1 day or the last visit in the double-blind (DB) period. SAEs are included up to the last of 1) the last treatment day + 30 days or 2) the last visit day + 30 days in the DB period.

Population: All treated participants.

ArmMeasureGroupValue (NUMBER)
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participant Adverse Event (AE), Related AE, Serious Adverse Event (SAE), Related SAE, and Discontinued Due to AEs SummaryDeaths0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participant Adverse Event (AE), Related AE, Serious Adverse Event (SAE), Related SAE, and Discontinued Due to AEs SummaryAt Least 1 Related SAE0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participant Adverse Event (AE), Related AE, Serious Adverse Event (SAE), Related SAE, and Discontinued Due to AEs SummaryAt Least 1 Related AE1 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participant Adverse Event (AE), Related AE, Serious Adverse Event (SAE), Related SAE, and Discontinued Due to AEs SummaryDiscontinued Due to SAEs0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participant Adverse Event (AE), Related AE, Serious Adverse Event (SAE), Related SAE, and Discontinued Due to AEs SummaryAt Least 1 SAE1 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participant Adverse Event (AE), Related AE, Serious Adverse Event (SAE), Related SAE, and Discontinued Due to AEs SummaryDiscontinued Due to AEs0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participant Adverse Event (AE), Related AE, Serious Adverse Event (SAE), Related SAE, and Discontinued Due to AEs SummaryAt Least 1 AE19 Participants
Placebo + Metformin IRParticipant Adverse Event (AE), Related AE, Serious Adverse Event (SAE), Related SAE, and Discontinued Due to AEs SummaryDiscontinued Due to AEs0 Participants
Placebo + Metformin IRParticipant Adverse Event (AE), Related AE, Serious Adverse Event (SAE), Related SAE, and Discontinued Due to AEs SummaryAt Least 1 AE34 Participants
Placebo + Metformin IRParticipant Adverse Event (AE), Related AE, Serious Adverse Event (SAE), Related SAE, and Discontinued Due to AEs SummaryAt Least 1 Related AE3 Participants
Placebo + Metformin IRParticipant Adverse Event (AE), Related AE, Serious Adverse Event (SAE), Related SAE, and Discontinued Due to AEs SummaryDeaths0 Participants
Placebo + Metformin IRParticipant Adverse Event (AE), Related AE, Serious Adverse Event (SAE), Related SAE, and Discontinued Due to AEs SummaryAt Least 1 SAE1 Participants
Placebo + Metformin IRParticipant Adverse Event (AE), Related AE, Serious Adverse Event (SAE), Related SAE, and Discontinued Due to AEs SummaryAt Least 1 Related SAE0 Participants
Placebo + Metformin IRParticipant Adverse Event (AE), Related AE, Serious Adverse Event (SAE), Related SAE, and Discontinued Due to AEs SummaryDiscontinued Due to SAEs0 Participants
Other Pre-specified

Participant Electrocardiogram (ECG) Status at Baseline and Week 12

Abnormal ECGs were defined as those not within the normal limits for the participant, according to the investigator. 'Shifted Normal to Abnormal' and 'Shifted Abnormal to Normal' references a change from measurements at Baseline to those at Week 12.

Time frame: Baseline, Week 12

Population: All treated participants, excluding those with missing values.

ArmMeasureGroupValue (NUMBER)
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participant Electrocardiogram (ECG) Status at Baseline and Week 12Baseline Normal36 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participant Electrocardiogram (ECG) Status at Baseline and Week 12Baseline Abnormal35 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participant Electrocardiogram (ECG) Status at Baseline and Week 12Week 12 Normal39 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participant Electrocardiogram (ECG) Status at Baseline and Week 12Week 12 Abnormal32 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participant Electrocardiogram (ECG) Status at Baseline and Week 12Shifted Normal to Abnormal5 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participant Electrocardiogram (ECG) Status at Baseline and Week 12Shifted Abnormal to Normal8 Participants
Placebo + Metformin IRParticipant Electrocardiogram (ECG) Status at Baseline and Week 12Shifted Normal to Abnormal4 Participants
Placebo + Metformin IRParticipant Electrocardiogram (ECG) Status at Baseline and Week 12Baseline Normal42 Participants
Placebo + Metformin IRParticipant Electrocardiogram (ECG) Status at Baseline and Week 12Week 12 Abnormal28 Participants
Placebo + Metformin IRParticipant Electrocardiogram (ECG) Status at Baseline and Week 12Baseline Abnormal36 Participants
Placebo + Metformin IRParticipant Electrocardiogram (ECG) Status at Baseline and Week 12Shifted Abnormal to Normal12 Participants
Placebo + Metformin IRParticipant Electrocardiogram (ECG) Status at Baseline and Week 12Week 12 Normal50 Participants
Other Pre-specified

Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality Criteria

A laboratory value was considered a marked abnormality if it is outside the pre-defined criteria for marked abnormality and the on-treatment value was more extreme (farther from the limit) than the baseline value. ULN=upper limit of normal; LLN=lower limit of normal.

Time frame: Baseline, Week 12

Population: All treated participants.

ArmMeasureGroupValue (NUMBER)
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaHemoglobin < 8 g/dL0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaHematocrit < 0.75 prior to dosing0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaPlatelets < 50 x 10^9 c/L0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaPlatelets > 1.5 x ULN0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaLeukocytes < 2 x 10^3 c/uL0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaNeutrophils < 1 x 10^3 c/uL1 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaEosinophils > 0.9 x 10^3 c/uL0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaLymphocytes <= 0.75 x 10^3 c/uL1 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaAlkaline Phosphatase >3x prior to dosing and > ULN0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaAspartate Aminotransferase > 3x ULN1 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaAspartate Aminotransferase > 5x ULN0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaAlanine Aminotransferase > 3x ULN1 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaAlanine Aminotransferase > 5x ULN0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaTotal Bilirubin > 2 mg/dL0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaTotal Bilirubin > 1.5x ULN0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaBlood Urea Nitrogen > 2x prior to dosing and > ULN0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaCreatinine > 2.5 mg/dL0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaSerum Sodium <0.9x pre-Rx and <= 130 mEq/0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaSerum Sodium >1.1x pre-Rx and >= 150 mEq/L0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaSerum Potassium <=0.8x pre-Rx and <= 3.2 mEq/L0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaSerum Potassium >=1.2x pre-Rx and >= 6.0 mEq/L1 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaSerum Chloride <90 mEq/L0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaSerum Chloride > 120 mEq/L0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaAlbumin <0.9x LLN, or if pre-Rx<LLN use <0.75x0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaCreatinine Kinase > 5x ULN0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaFasting Plasma Glucose < 50 mg/dL1 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaFasting Plasma Glucose > 500 mg/dL0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaPlasma Glucose Unspecified < 50 mg/dL0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaPlasma Glucose Unspecified > 500 mg/dL0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaTotal Bilirubin > 1.5x ULN1 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaHemoglobin < 8 g/dL0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaFasting Plasma Glucose < 50 mg/dL0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaHematocrit < 0.75 prior to dosing0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaBlood Urea Nitrogen > 2x prior to dosing and > ULN0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaPlatelets < 50 x 10^9 c/L0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaSerum Chloride > 120 mEq/L0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaPlatelets > 1.5 x ULN0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaCreatinine > 2.5 mg/dL0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaLeukocytes < 2 x 10^3 c/uL0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaPlasma Glucose Unspecified < 50 mg/dL0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaNeutrophils < 1 x 10^3 c/uL0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaSerum Sodium <0.9x pre-Rx and <= 130 mEq/0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaEosinophils > 0.9 x 10^3 c/uL2 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaAlbumin <0.9x LLN, or if pre-Rx<LLN use <0.75x0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaLymphocytes <= 0.75 x 10^3 c/uL0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaSerum Sodium >1.1x pre-Rx and >= 150 mEq/L0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaAlkaline Phosphatase >3x prior to dosing and > ULN0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaFasting Plasma Glucose > 500 mg/dL0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaAspartate Aminotransferase > 3x ULN0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaSerum Potassium <=0.8x pre-Rx and <= 3.2 mEq/L0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaAspartate Aminotransferase > 5x ULN0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaCreatinine Kinase > 5x ULN1 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaAlanine Aminotransferase > 3x ULN0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaSerum Potassium >=1.2x pre-Rx and >= 6.0 mEq/L0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaAlanine Aminotransferase > 5x ULN0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaPlasma Glucose Unspecified > 500 mg/dL0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaTotal Bilirubin > 2 mg/dL0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Laboratory Parameters That Met the Marked Abnormality CriteriaSerum Chloride <90 mEq/L0 Participants
Other Pre-specified

Participants Experiencing Changes From Baseline in Urinalysis Parameters That Met the Marked Abnormality Criteria

Marked abnormality criteria were urine protein: if pre-Rx=o use \>=2, if pre-Rx =0.5 or 1 use \>=3, if pre-Rx =2, use \>=4; urine blood: if pre-Rx=0, use \>=2, if pre-Rx=0.5 or 1, use \>=3, if pre-Rx=2, use \>=4; Urine red blood cell count (RBC): if pre-Rx=o use \>=2, if pre-Rx =0.5 or 1 use \>=3, if pre-Rx =2, use \>=4; urine white blood cell count (WBC): if pre-Rx=o use \>=2, if pre-Rx =0.5 or 1 use \>=3, if pre-Rx =2, use \>=4.

Time frame: Baseline, Week 12

Population: All treated participants. N = number of participants analyzed and n = the number of participants with values available for each specific measurement.

ArmMeasureGroupValue (NUMBER)
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Urinalysis Parameters That Met the Marked Abnormality CriteriaUrine Protein (n=74, 84)0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Urinalysis Parameters That Met the Marked Abnormality CriteriaUrine Blood (n=74, 84)1 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Urinalysis Parameters That Met the Marked Abnormality CriteriaUrine Red Blood Cells (n=7, 10)0 Participants
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants Experiencing Changes From Baseline in Urinalysis Parameters That Met the Marked Abnormality CriteriaUrine White Blood Cells (n=16, 18)2 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Urinalysis Parameters That Met the Marked Abnormality CriteriaUrine White Blood Cells (n=16, 18)2 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Urinalysis Parameters That Met the Marked Abnormality CriteriaUrine Protein (n=74, 84)0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Urinalysis Parameters That Met the Marked Abnormality CriteriaUrine Red Blood Cells (n=7, 10)0 Participants
Placebo + Metformin IRParticipants Experiencing Changes From Baseline in Urinalysis Parameters That Met the Marked Abnormality CriteriaUrine Blood (n=74, 84)1 Participants
Other Pre-specified

Participants With Confirmed Hypoglycemia

Confirmed hypoglycemia was defined by a fingerstick glucose value \<= 50 mg/dL with associated hypoglycemia symptoms.

Time frame: Week 1 to Week 12; AEs are included up to the last treatment day + 1 day or the last visit in the DB period. SAEs are included up to the last of 1) the last treatment day + 30 days or 2) the last visit day + 30 days in the DB period.

Population: All treated participants.

ArmMeasureValue (NUMBER)
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants With Confirmed Hypoglycemia0 Participants
Placebo + Metformin IRParticipants With Confirmed Hypoglycemia1 Participants
Other Pre-specified

Participants With Reported Hypoglycemia AEs During Double-Blind Treatment Period

Hypoglycemic Events are based upon the Saxagliptin Predefined List of Events, which included hypoglycemia, blood glucose decreased, and hypoglycemic unconsciousness.

Time frame: Week 1 to Week 12; AEs are included up to the last treatment day + 1 day or the last visit in the DB period. SAEs are included up to the last of 1) the last treatment day + 30 days or 2) the last visit day + 30 days in the DB period.

Population: All treated participants.

ArmMeasureValue (NUMBER)
Saxagliptin 2.5 mg + Metformin Immediate Release (IR)Participants With Reported Hypoglycemia AEs During Double-Blind Treatment Period4 Participants
Placebo + Metformin IRParticipants With Reported Hypoglycemia AEs During Double-Blind Treatment Period1 Participants

Source: ClinicalTrials.gov · Data processed: Mar 21, 2026