Type 2 Diabetes Mellitus
Conditions
Brief summary
The purpose of this study is to investigate the effect of bexagliflozin compared to sitagliptin as an add-on therapy to metformin in lowering hemoglobin A1c (HbA1c) levels in subjects with type 2 diabetes mellitus (T2DM).
Detailed description
This was a phase 3, multi-center, randomized, double-blind, parallel-group study to demonstrate that bexagliflozin was non-inferior to sitagliptin as add-on therapy in subjects whose T2DM was not adequately controlled by metformin treatment alone. The primary effectiveness endpoint was the change in HbA1c from baseline at week 24. At the time of screening, all subjects were to have taken metformin at a stable dose of ≥ 1500 mg per day for ≥ 8 weeks and have received diet and exercise counseling. A total of 374 eligible subjects were to be enrolled in the study. Subjects who successfully completed a 1-week run-in and who met all eligibility criteria were to be randomized in a 1:1 ratio to receive once daily double-blind treatment of either active bexagliflozin tablets with placebo sitagliptin tablets or placebo bexagliflozin tablets and active sitagliptin tablets. The study subjects were to continue receiving open-labeled metformin during the entire study at a stable dose and frequency. The treatment period was 24 weeks and was conducted in an outpatient setting. Randomization was stratified by HbA1c (≤ 8.5% vs. ˃ 8.5%) values. Symptoms and blood sugars related to the occurrence of hyperglycemia, hypoglycemic events or symptoms that could indicate ketoacidosis were to be recorded. Bexagliflozin tablets, 20 mg or placebo, and sitagliptin tablets, 100 mg or placebo, were to be taken once daily at approximately the same time each day either before or after breakfast. Background metformin was to be taken at the same dose and frequency from screening throughout the entire study. Each subject was advised to return to the clinic at weeks 6, 12, 18 and 24 for efficacy assessment and safety monitoring, including review of AEs and concomitant medication, vital signs, ECG, physical examination and blood and urine specimen collections. Subjects were to return to the clinic for a follow-up exit visit at week 26 or 2 weeks after the last dose of study drugs if subjects withdrew from the study prior to week 24.
Interventions
tablets containing 20 mg bexagliflozin
tablets containing 100 mg sitagliptin
inactive tablets to match the appearance of sitagliptin tablets
inactive tablets to match the appearance of bexagliflozin tablets
Sponsors
Study design
Eligibility
Inclusion criteria
Each subject was required to meet the following criteria at the time of enrollment to be eligible for the study: 1. To have been male or female adults ≥ 18 years of age. 2. To have been negative on the urine pregnancy test and agreed to abstain from coitus or use contraception during the entire study if a subject was female of childbearing potential. 3. To have had a diagnosis of T2DM with HbA1c levels between 7.0% and 11% (inclusive) at the time of screening. 4. To have been treated with a stable dose of ≥ 1500 mg/day metformin only along with diet and exercise counseling for at least 8 weeks at the time of screening. 5. To have had a BMI ≤ 45 kg per m2 at the time of screening. 6. To have been taking stable doses of treatment for dyslipidemia and/or hypertension for 30 days if applicable. 7. To have been willing and able to return for all clinic visits and to complete all study-required procedures. 8. To have adhered to the investigational product administration requirements as evidenced by missing no more than 1 day of run-in medications. Potential subjects who exhibited any of the following characteristics were to be excluded from the study: 1. Diagnosis of type 1 diabetes mellitus or maturity-onset diabetes of the young (MODY) 2. Hemoglobinopathy that affected HbA1c measurement 3. Any contraindication to the safe use of DPP-4 therapy or sitagliptin, including known hypersensitivity reaction 4. History of pancreatitis 5. Genitourinary tract infection within 6 weeks of screening or history of ≥ 3 genitourinary infections requiring treatment within 6 months from the time of screening 6. Cancer, active or in remission, for \< 3 years 7. History of alcohol or illicit drug abuse in the past 2 years 8. Triglycerides \> 500 mg dL-1 at Visit V1 9. Evidence of abnormal liver function tests (total bilirubin or alkaline phosphatase \> 1.5 x upper limit of normal (ULN) with the exception of isolated Gilbert's syndrome); or alanine aminotransferase (ALT) or aspartate aminotransferase (AST) \> 2.5 x ULN 10. Estimated GFR, as calculated by the modification of diet in renal disease study equation (MDRD), \< 60 mL min-1 per 1.73 m2 at the time of screening. 11. Uncontrolled hypertension (SBP \> 160 mm Hg or diastolic BP \> 95 mm Hg) at Visit V1 12. Life expectancy \< 2 years 13. History of MI, unstable angina, stroke or hospitalization for heart failure within 3 months at the time of screening 14. History of treatment with an investigational drug within 30 days or within 7 half-lives of the investigational drug, whichever is longer 15. Previous treatment with bexagliflozin or EGT0001474 study drug 16. Currently or within 3 months of taking any SGLT2 inhibitor 17. Currently participating in another interventional trial 18. Prior renal transplantation or evidence of nephrotic syndrome (defined as a urine albumin-to-creatinine ratio (UACR) \> 1500 mg g-1 at the time of screening). 19. Any condition, disease, disorder or clinically relevant abnormality that could have jeopardized the subject's appropriate participation in this study or obscure the effects of treatment 20. Female subjects who were pregnant or nursing 21. Two or more consecutive SMBG measures ≥ 250 mg dL-1 (13.9 mmol L-1) prior to randomization accompanied by clinical signs or symptoms of hyperglycemia prior to randomization, including weight loss, blurred vision, increased thirst increased urination, or fatigue
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in HbA1c From Baseline to Week 24 | Baseline to week 24 | The primary efficacy objective is to demonstrate that bexagliflozin is non-inferior to sitagliptin by evaluating the treatment effect on hemoglobin A1c (HbA1c) reduction at week 24 in subjects whose type 2 diabetes mellitus (T2DM) is inadequately controlled by metformin. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in FPG From Baseline at Week 24 | Baseline to week 24 | To evaluate the treatment effect of bexagliflozin vs. sitagliptin on the change in fasting plasma glucose (FPG) at week 24 |
| Change in Body Weight in Subjects With Baseline BMI ≥ 25 kg/m2 at Week 24 | Baseline to week 24 | To evaluate the treatment effect of bexagliflozin vs. sitagliptin on the change in body weight in subjects with baseline body mass index (BMI) ≥ 25 kg/m2 at week 24 |
| Change in SBP in Subjects From Baseline at Week 24 | Baseline to week 24 | To evaluate the treatment effect of bexagliflozin vs. sitagliptin on the change in systolic blood pressure (SBP) in subjects at week 24 |
Countries
Czechia, Hungary, Japan, Poland, Spain, United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Bexagliflozin Subjects will receive a bexagliflozin tablet, 20 mg, once daily for the duration of the study. Subjects will continue taking metformin and receive placebo for sitagliptin daily for the duration of the study. | 191 |
| Sitagliptin Subjects will receive a sitagliptin tablet, 100 mg, once daily for the duration of the study. Subjects will continue taking metformin and receive placebo for bexagliflozin for the duration of the study. | 193 |
| Total | 384 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Adverse Event | 5 | 1 |
| Overall Study | Death | 1 | 0 |
| Overall Study | Lost to Follow-up | 0 | 1 |
| Overall Study | Pregnancy | 1 | 0 |
| Overall Study | Site closure | 1 | 1 |
| Overall Study | Withdrawal by Subject | 4 | 2 |
Baseline characteristics
| Characteristic | Sitagliptin | Total | Bexagliflozin |
|---|---|---|---|
| Age, Continuous | 59.6 years STANDARD_DEVIATION 9.76 | 59.4 years STANDARD_DEVIATION 9.72 | 59.3 years STANDARD_DEVIATION 9.69 |
| BMI | 31.39 kg/m^2 STANDARD_DEVIATION 5.294 | 31.72 kg/m^2 STANDARD_DEVIATION 5.686 | 32.06 kg/m^2 STANDARD_DEVIATION 6.052 |
| Body Weight | 89.44 kg STANDARD_DEVIATION 19.235 | 89.85 kg STANDARD_DEVIATION 19.974 | 90.27 kg STANDARD_DEVIATION 20.736 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 7 Participants | 10 Participants | 3 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 186 Participants | 374 Participants | 188 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| HbA1c | 8.03 percentage of glycated hemoglobin STANDARD_DEVIATION 0.921 | 7.99 percentage of glycated hemoglobin STANDARD_DEVIATION 0.867 | 7.94 percentage of glycated hemoglobin STANDARD_DEVIATION 0.808 |
| Height | 168.3 cm STANDARD_DEVIATION 9.63 | 167.9 cm STANDARD_DEVIATION 10.16 | 167.4 cm STANDARD_DEVIATION 10.67 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 35 Participants | 62 Participants | 27 Participants |
| Race (NIH/OMB) Black or African American | 2 Participants | 8 Participants | 6 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 156 Participants | 314 Participants | 158 Participants |
| Region of Enrollment Czechia | 25 participants | 41 participants | 16 participants |
| Region of Enrollment Hungary | 23 participants | 56 participants | 33 participants |
| Region of Enrollment Japan | 35 participants | 62 participants | 27 participants |
| Region of Enrollment Poland | 44 participants | 114 participants | 70 participants |
| Region of Enrollment Spain | 45 participants | 75 participants | 30 participants |
| Region of Enrollment United States | 21 participants | 36 participants | 15 participants |
| Sex: Female, Male Female | 67 Participants | 138 Participants | 71 Participants |
| Sex: Female, Male Male | 126 Participants | 246 Participants | 120 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 1 / 191 | 0 / 193 |
| other Total, other adverse events | 28 / 191 | 47 / 193 |
| serious Total, serious adverse events | 7 / 191 | 4 / 193 |
Outcome results
Change in HbA1c From Baseline to Week 24
The primary efficacy objective is to demonstrate that bexagliflozin is non-inferior to sitagliptin by evaluating the treatment effect on hemoglobin A1c (HbA1c) reduction at week 24 in subjects whose type 2 diabetes mellitus (T2DM) is inadequately controlled by metformin.
Time frame: Baseline to week 24
Population: Subjects in the intention-to-treat population and with a value at baseline and at week 24 were included.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Bexagliflozin | Change in HbA1c From Baseline to Week 24 | -0.74 percentage of HbA1c |
| Sitagliptin | Change in HbA1c From Baseline to Week 24 | -0.82 percentage of HbA1c |
Change in Body Weight in Subjects With Baseline BMI ≥ 25 kg/m2 at Week 24
To evaluate the treatment effect of bexagliflozin vs. sitagliptin on the change in body weight in subjects with baseline body mass index (BMI) ≥ 25 kg/m2 at week 24
Time frame: Baseline to week 24
Population: Subjects in the intention-to-treat population with a baseline body mass index \>= 25 kg/m2 and had body weight values at baseline and at week 24 were included in the analysis.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Bexagliflozin | Change in Body Weight in Subjects With Baseline BMI ≥ 25 kg/m2 at Week 24 | -3.35 kg |
| Sitagliptin | Change in Body Weight in Subjects With Baseline BMI ≥ 25 kg/m2 at Week 24 | -0.81 kg |
Change in FPG From Baseline at Week 24
To evaluate the treatment effect of bexagliflozin vs. sitagliptin on the change in fasting plasma glucose (FPG) at week 24
Time frame: Baseline to week 24
Population: Subjects in the intention-to-treat population and with values at baseline and at week 24 were included.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Bexagliflozin | Change in FPG From Baseline at Week 24 | -1.82 mmol/L |
| Sitagliptin | Change in FPG From Baseline at Week 24 | -1.45 mmol/L |
Change in SBP in Subjects From Baseline at Week 24
To evaluate the treatment effect of bexagliflozin vs. sitagliptin on the change in systolic blood pressure (SBP) in subjects at week 24
Time frame: Baseline to week 24
Population: Subjects in the intention-to-treat population with values at baseline and at week 24 were included.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) |
|---|---|---|
| Bexagliflozin | Change in SBP in Subjects From Baseline at Week 24 | -4.23 mm Hg |
| Sitagliptin | Change in SBP in Subjects From Baseline at Week 24 | -1.90 mm Hg |