Type 2 Diabetes Mellitus
Conditions
Brief summary
This study compared the effect of delayed-release metformin (Met DR) to placebo and extended release metformin (Met XR) on glycemic control (fasting plasma glucose and HbA1c) and body weight, and assessed the safety and tolerability of a range of doses of Met DR when administered in subjects with type 2 diabetes mellitus (T2DM).
Interventions
Sponsors
Elcelyx Therapeutics, Inc.
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 65 Years
Healthy volunteers
No
Inclusion criteria
1. Male or female with T2DM who was ≥18 and ≤65 years of age at Visit 1 2. Had a body mass index (BMI) of 25.0 kg/m² to 45.0 kg/m², inclusive, at Visit 1 3. Screening HbA1c 7.0 to 9.5% (inclusive) at Visit 1 if treated with diet and exercise alone, or 6.0 to 9.5% (inclusive) if on a stable dose of either metformin or DPP-4 inhibitor monotherapy for a minimum of 2 months at Visit 1, or a combination of these 2 agents only on a stable regimen for a minimum of 2 months at Visit 1 4. Had serum creatinine concentration of \<1.5 mg/dL (male) or \<1.4 mg/dL (female) and an estimated glomerular filtration rate (eGFR) of ≥60 mL/min/1.73 m² based on the Modification of Diet in Renal Disease (MDRD) equation 5. Had a fasting glucose concentration of \<280 mg/dL at Visit 1 6. Had a stable body weight, i.e., not varying by \>5% for at least 6 months prior to Visit 1 as documented by the investigator 7. Was male, or if female and met all of the following criteria: 1. Not breastfeeding 2. Negative pregnancy test result (human chorionic gonadotropin, beta subunit \[βhCG\]) at Visit 1 (not applicable to hysterectomized females) 3. If of child bearing potential (including perimenopausal women who have had a menstrual period within 1 year), must have practiced and be willing to continue to practice appropriate birth control during the entire duration of the study 8. Had a physical examination and ECG with no clinically significant abnormalities as judged by the investigator at Visit 1 9. Had no clinically significant laboratory test values (clinical chemistry, hematology, urinalysis) other than those expected in subjects with diabetes as judged by the investigator at Visit 1 10. Either was not treated with or had been on a stable treatment regimen with any of the following medications for a minimum of 2 months prior to Visit 1: 1. Hormone replacement therapy (female subjects) 2. Oral contraceptives (female subjects) 3. Antihypertensive agents 4. Lipid-lowering agents 5. Thyroid replacement therapy 6. Antidepressant agents 7. Testosterone therapy (male subjects) 11. If on chronic thyroid pharmacologic therapy, had a serum thyroid-stimulating hormone test result within the normal range at Visit 1 12. Was willing and able to follow study procedures 13. Was able to read, understand, and sign the Informed Consent Form and an Authorization to Use and Disclose Protected Health Information form, answer the study questions, communicate with the investigator, and understand and comply with protocol requirements
Exclusion criteria
1. Had a clinically significant medical condition that could potentially affect study participation and/or personal well-being, as judged by the investigator, including but not limited to the following conditions: 1. Hepatic disease 2. Renal disease 3. Gastrointestinal disease 4. Endocrine disorder except T2DM 5. Cardiovascular disease 6. Central nervous system diseases 7. Psychiatric or neurological disorders 8. Organ transplantation 9. Chronic or acute infection (e.g., tuberculosis, human immunodeficiency virus, hepatitis B virus, or hepatitis C virus) 10. Orthostatic hypotension, fainting spells or blackouts 11. Allergy or hypersensitivity 2. Clinically significant malignant disease (with the exception of basal and squamous cell carcinoma of the skin) within 5 years of Visit 1 3. Had known hypersensitivity, intolerability, or allergies to metformin HCl or any component of study treatment 4. Had a physical, psychological, or historical finding that, in the investigator's opinion, would make the subject unsuitable for the study 5. Current drugs or alcohol abuse or had a history of abuse that in the investigator's opinion would cause the individual to be noncompliant with study procedures 6. Had major surgery or a blood transfusion within 2 months of Visit 1 or was planning to donate blood during the study, or had a significant blood loss within 2 months prior to Visit 1 7. Had been treated, was being treated, or was expected to require or undergo treatment with any of the following excluded medications: 1. Insulin or sulphonylurea treatment within 3 months of Visit 1 2. GLP-1 receptor agonists and/or thiazolidinedione treatment within 6 months of Visit 1 3. Nifedipine within 3 months of Visit 1 4. Systemic corticosteroids by oral, intravenous, intra-articular, or intra-muscular route within 30 days of screening or for more than 1 week within 3 months of Visit 1 5. Prescription weight loss medications within 3 months of Visit 1 6. Chronic or frequent use, in the judgment of the investigator, of any drug treatment that affects gastric pH (prescription or over-the-counter), including proton pump inhibitors or any antacids or medications such as Rolaids or Pepcid within 1 month of Visit 1 7. Had received or planned to receive any iodinated contrast dye within 1 week prior to Visit 1 (Screening) 8. Had a surgical gastrointestinal procedure that may impact the gut hormonal response to study medication 9. History or presence of inflammatory bowel disease or other severe gastrointestinal disease, particularly those which may impact gastric emptying, such as gastroparesis, pyloric stenosis, gastric bypass surgery or gastric banding surgery 10. Had received any investigational drug within 30 days (or five half-lives of the investigational drug, whichever was greater) of Visit 1 11. Was an immediate family member (spouse, parent, child, or sibling; biological or legally adopted) of personnel directly affiliated with the study at the clinical study site, or was directly affiliated with the study at the clinical study site 12. Was employed by Elcelyx Therapeutics, Inc. (that is an employee, temporary contract worker, or designee responsible for the conduct of the study)
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Change in Fasting Plasma Glucose (mg/dL) at 4 Weeks | Baseline and 4 weeks after the first dose of study medication |
Secondary
| Measure | Time frame |
|---|---|
| AUC4-12wk of Change in Fasting Plasma Glucose (mg/dL*Week) Concentrations From Baseline to 12 Weeks | Baseline and 4 to 12 weeks after the first dose of study medication |
| Change in HbA1c (%) at 12 Weeks | Baseline and 12 weeks after the first dose of study medication |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Placebo Placebo once daily in the morning | 41 |
| 600 mg DR 600 mg delayed-release metformin once daily in the morning
Met DR: metformin delayed-release tablets | 39 |
| 800 mg DR 800 mg delayed-release metformin once daily in the morning
Met DR: metformin delayed-release tablets | 40 |
| 1000 mg DR 1000 mg delayed-release metformin once daily in the morning
Met DR: metformin delayed-release tablets | 40 |
| 1000 mg XR 1000 mg extended-release metformin once daily in the evening
Met XR: metformin extended-release tablets | 40 |
| 2000 mg XR 2000 mg extended-release metformin once daily in the evening
Met XR: metformin extended-release tablets | 40 |
| Total | 240 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 | FG004 | FG005 |
|---|---|---|---|---|---|---|---|
| Overall Study | Adverse Event | 1 | 0 | 0 | 2 | 0 | 0 |
| Overall Study | Loss of Glucose Control | 2 | 1 | 0 | 1 | 2 | 0 |
| Overall Study | Lost to Follow-up | 3 | 0 | 1 | 0 | 0 | 3 |
| Overall Study | Physician Decision | 0 | 1 | 0 | 0 | 0 | 0 |
| Overall Study | Protocol Violation | 0 | 0 | 0 | 1 | 2 | 3 |
| Overall Study | Withdrawal of Consent | 0 | 1 | 2 | 1 | 0 | 1 |
Baseline characteristics
| Characteristic | 600 mg DR | Total | 2000 mg XR | 1000 mg XR | 1000 mg DR | 800 mg DR | Placebo |
|---|---|---|---|---|---|---|---|
| Age, Continuous | 53.5 years STANDARD_DEVIATION 8.34 | 52.0 years STANDARD_DEVIATION 9.37 | 52.0 years STANDARD_DEVIATION 9.53 | 51.0 years STANDARD_DEVIATION 9.62 | 51.8 years STANDARD_DEVIATION 9.05 | 52.6 years STANDARD_DEVIATION 9.69 | 51.4 years STANDARD_DEVIATION 10.22 |
| Baseline Fasting Plasma Glucose | 180.1 mg/dL STANDARD_DEVIATION 49.72 | 173.0 mg/dL STANDARD_DEVIATION 49.72 | 180.3 mg/dL STANDARD_DEVIATION 57.52 | 165.7 mg/dL STANDARD_DEVIATION 50.01 | 172.3 mg/dL STANDARD_DEVIATION 44.45 | 162.9 mg/dL STANDARD_DEVIATION 40.1 | 176.5 mg/dL STANDARD_DEVIATION 54.7 |
| Baseline HbA1c | 7.45 % STANDARD_DEVIATION 0.887 | 7.38 % STANDARD_DEVIATION 0.928 | 7.38 % STANDARD_DEVIATION 0.98 | 7.36 % STANDARD_DEVIATION 0.997 | 7.37 % STANDARD_DEVIATION 0.89 | 7.33 % STANDARD_DEVIATION 0.908 | 7.40 % STANDARD_DEVIATION 0.951 |
| BMI | 33.1 kg/m² STANDARD_DEVIATION 5.74 | 33.3 kg/m² STANDARD_DEVIATION 5.44 | 33.7 kg/m² STANDARD_DEVIATION 5.22 | 32.8 kg/m² STANDARD_DEVIATION 5.27 | 33.3 kg/m² STANDARD_DEVIATION 5.55 | 33.5 kg/m² STANDARD_DEVIATION 5.86 | 33.6 kg/m² STANDARD_DEVIATION 5.28 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 14 Participants | 75 Participants | 10 Participants | 10 Participants | 14 Participants | 10 Participants | 17 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 25 Participants | 165 Participants | 30 Participants | 30 Participants | 26 Participants | 30 Participants | 24 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Previous T2DM Regimen Diet and exercise alone | 7 participants | 27 participants | 5 participants | 6 participants | 4 participants | 2 participants | 3 participants |
| Previous T2DM Regimen DPP-4 inhibitor alone | 1 participants | 1 participants | 0 participants | 0 participants | 0 participants | 0 participants | 0 participants |
| Previous T2DM Regimen Metformin alone | 29 participants | 198 participants | 33 participants | 30 participants | 36 participants | 35 participants | 35 participants |
| Previous T2DM Regimen Metformin/DPP-4 inhibitor combination | 2 participants | 14 participants | 2 participants | 4 participants | 0 participants | 3 participants | 3 participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 6 Participants | 0 Participants | 2 Participants | 0 Participants | 3 Participants | 1 Participants |
| Race (NIH/OMB) Black or African American | 9 Participants | 68 Participants | 12 Participants | 14 Participants | 9 Participants | 13 Participants | 11 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 1 Participants | 0 Participants | 0 Participants | 0 Participants | 1 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 2 Participants | 1 Participants | 0 Participants | 1 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 30 Participants | 162 Participants | 27 Participants | 24 Participants | 30 Participants | 23 Participants | 28 Participants |
| Screening Fasting Plasma Glucose | 147.5 mg/dL STANDARD_DEVIATION 42.56 | 144.3 mg/dL STANDARD_DEVIATION 36.57 | 148.9 mg/dL STANDARD_DEVIATION 41.36 | 139.0 mg/dL STANDARD_DEVIATION 34.22 | 141.4 mg/dL STANDARD_DEVIATION 29.79 | 142.4 mg/dL STANDARD_DEVIATION 34.6 | 146.5 mg/dL STANDARD_DEVIATION 36.7 |
| Screening HbA1c | 7.27 % STANDARD_DEVIATION 0.864 | 7.17 % STANDARD_DEVIATION 0.846 | 7.17 % STANDARD_DEVIATION 0.869 | 7.10 % STANDARD_DEVIATION 0.819 | 7.13 % STANDARD_DEVIATION 0.899 | 7.17 % STANDARD_DEVIATION 0.829 | 7.19 % STANDARD_DEVIATION 0.838 |
| Sex: Female, Male Female | 21 Participants | 127 Participants | 21 Participants | 22 Participants | 14 Participants | 27 Participants | 22 Participants |
| Sex: Female, Male Male | 18 Participants | 113 Participants | 19 Participants | 18 Participants | 26 Participants | 13 Participants | 19 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk |
|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 9 / 41 | 9 / 39 | 11 / 40 | 9 / 40 | 8 / 40 | 8 / 40 |
| serious Total, serious adverse events | 0 / 41 | 1 / 39 | 0 / 40 | 2 / 40 | 1 / 40 | 0 / 40 |
Outcome results
Primary
Change in Fasting Plasma Glucose (mg/dL) at 4 Weeks
Time frame: Baseline and 4 weeks after the first dose of study medication
Population: Week 4 Evaluable
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo | Change in Fasting Plasma Glucose (mg/dL) at 4 Weeks | -4 mg/dL |
| 600 mg DR | Change in Fasting Plasma Glucose (mg/dL) at 4 Weeks | -11 mg/dL |
| 800 mg DR | Change in Fasting Plasma Glucose (mg/dL) at 4 Weeks | -13 mg/dL |
| 1000 mg DR | Change in Fasting Plasma Glucose (mg/dL) at 4 Weeks | -18 mg/dL |
| 1000 mg XR | Change in Fasting Plasma Glucose (mg/dL) at 4 Weeks | -12 mg/dL |
| 2000 mg XR | Change in Fasting Plasma Glucose (mg/dL) at 4 Weeks | -25 mg/dL |
p-value: 0.06795% CI: [-21, 1]Kruskal-Wallis
p-value: 0.005795% CI: [-22, -4]Kruskal-Wallis
p-value: 0.109595% CI: [-25, 3]Kruskal-Wallis
p-value: 0.009795% CI: [-23, -3]Kruskal-Wallis
p-value: <0.000195% CI: [-42, -17]Kruskal-Wallis
Secondary
AUC4-12wk of Change in Fasting Plasma Glucose (mg/dL*Week) Concentrations From Baseline to 12 Weeks
Time frame: Baseline and 4 to 12 weeks after the first dose of study medication
Population: Week 12 Evaluable
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Placebo | AUC4-12wk of Change in Fasting Plasma Glucose (mg/dL*Week) Concentrations From Baseline to 12 Weeks | 4.00 mg/dL*week |
| 600 mg DR | AUC4-12wk of Change in Fasting Plasma Glucose (mg/dL*Week) Concentrations From Baseline to 12 Weeks | -96.00 mg/dL*week |
| 800 mg DR | AUC4-12wk of Change in Fasting Plasma Glucose (mg/dL*Week) Concentrations From Baseline to 12 Weeks | -108.00 mg/dL*week |
| 1000 mg DR | AUC4-12wk of Change in Fasting Plasma Glucose (mg/dL*Week) Concentrations From Baseline to 12 Weeks | -156.00 mg/dL*week |
| 1000 mg XR | AUC4-12wk of Change in Fasting Plasma Glucose (mg/dL*Week) Concentrations From Baseline to 12 Weeks | -98.00 mg/dL*week |
| 2000 mg XR | AUC4-12wk of Change in Fasting Plasma Glucose (mg/dL*Week) Concentrations From Baseline to 12 Weeks | -215.00 mg/dL*week |
p-value: 0.022695% CI: [-208, -16]Kruskal-Wallis
p-value: 0.006895% CI: [-180, -32]Kruskal-Wallis
p-value: 0.007195% CI: [-252, -42]Kruskal-Wallis
p-value: 0.040595% CI: [-208, -4]Kruskal-Wallis
p-value: <0.000195% CI: [-334, -118]Kruskal-Wallis
Secondary
Change in HbA1c (%) at 12 Weeks
Time frame: Baseline and 12 weeks after the first dose of study medication
Population: Week 12 Evaluable
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change in HbA1c (%) at 12 Weeks | 0.45 HbA1c (%) | Standard Error 0.137 |
| 600 mg DR | Change in HbA1c (%) at 12 Weeks | -0.03 HbA1c (%) | Standard Error 0.125 |
| 800 mg DR | Change in HbA1c (%) at 12 Weeks | 0.00 HbA1c (%) | Standard Error 0.121 |
| 1000 mg DR | Change in HbA1c (%) at 12 Weeks | 0.10 HbA1c (%) | Standard Error 0.124 |
| 1000 mg XR | Change in HbA1c (%) at 12 Weeks | 0.00 HbA1c (%) | Standard Error 0.132 |
| 2000 mg XR | Change in HbA1c (%) at 12 Weeks | -0.21 HbA1c (%) | Standard Error 0.133 |
p-value: 0.0195% CI: [-0.85, -0.12]ANCOVA
p-value: 0.015395% CI: [-0.81, -0.09]ANCOVA
p-value: 0.061195% CI: [-0.71, 0.02]ANCOVA
p-value: 0.018895% CI: [-0.83, -0.08]ANCOVA
p-value: 0.000695% CI: [-1.04, -0.29]ANCOVA