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Safety and Efficacy of Bexagliflozin Compared to Sitagliptin as Add-on Therapy to Metformin in Type 2 Diabetes Subjects

A Phase 3, Randomized, Double-Blind, Active-Controlled Study to Evaluate the Effects of Bexagliflozin Versus Sitagliptin in Subjects With Type 2 Diabetes Mellitus Who Have Inadequate Glycemic Control by Metformin

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT03115112
Enrollment
386
Registered
2017-04-14
Start date
2017-10-12
Completion date
2018-10-31
Last updated
2021-06-22

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 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

DRUGSitagliptin

tablets containing 100 mg sitagliptin

inactive tablets to match the appearance of sitagliptin tablets

inactive tablets to match the appearance of bexagliflozin tablets

Sponsors

Theracos
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 No maximum
Healthy volunteers
No

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

MeasureTime frameDescription
Change in HbA1c From Baseline to Week 24Baseline to week 24The 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

MeasureTime frameDescription
Change in FPG From Baseline at Week 24Baseline to week 24To 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 24Baseline to week 24To 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 24Baseline to week 24To 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

ArmCount
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
Total384

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyAdverse Event51
Overall StudyDeath10
Overall StudyLost to Follow-up01
Overall StudyPregnancy10
Overall StudySite closure11
Overall StudyWithdrawal by Subject42

Baseline characteristics

CharacteristicSitagliptinTotalBexagliflozin
Age, Continuous59.6 years
STANDARD_DEVIATION 9.76
59.4 years
STANDARD_DEVIATION 9.72
59.3 years
STANDARD_DEVIATION 9.69
BMI31.39 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 Weight89.44 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 Participants10 Participants3 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
186 Participants374 Participants188 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
HbA1c8.03 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
Height168.3 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 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
35 Participants62 Participants27 Participants
Race (NIH/OMB)
Black or African American
2 Participants8 Participants6 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
156 Participants314 Participants158 Participants
Region of Enrollment
Czechia
25 participants41 participants16 participants
Region of Enrollment
Hungary
23 participants56 participants33 participants
Region of Enrollment
Japan
35 participants62 participants27 participants
Region of Enrollment
Poland
44 participants114 participants70 participants
Region of Enrollment
Spain
45 participants75 participants30 participants
Region of Enrollment
United States
21 participants36 participants15 participants
Sex: Female, Male
Female
67 Participants138 Participants71 Participants
Sex: Female, Male
Male
126 Participants246 Participants120 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
1 / 1910 / 193
other
Total, other adverse events
28 / 19147 / 193
serious
Total, serious adverse events
7 / 1914 / 193

Outcome results

Primary

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.

ArmMeasureValue (LEAST_SQUARES_MEAN)
BexagliflozinChange in HbA1c From Baseline to Week 24-0.74 percentage of HbA1c
SitagliptinChange in HbA1c From Baseline to Week 24-0.82 percentage of HbA1c
95% CI: [-0.07, 0.22]
Secondary

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.

ArmMeasureValue (LEAST_SQUARES_MEAN)
BexagliflozinChange in Body Weight in Subjects With Baseline BMI ≥ 25 kg/m2 at Week 24-3.35 kg
SitagliptinChange in Body Weight in Subjects With Baseline BMI ≥ 25 kg/m2 at Week 24-0.81 kg
p-value: <0.000195% CI: [-3.15, -1.92]Mixed-effects repeated measures
Secondary

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.

ArmMeasureValue (LEAST_SQUARES_MEAN)
BexagliflozinChange in FPG From Baseline at Week 24-1.82 mmol/L
SitagliptinChange in FPG From Baseline at Week 24-1.45 mmol/L
p-value: 0.012395% CI: [-0.7, -0.05]Mixed-effects repeated measures
Secondary

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.

ArmMeasureValue (LEAST_SQUARES_MEAN)
BexagliflozinChange in SBP in Subjects From Baseline at Week 24-4.23 mm Hg
SitagliptinChange in SBP in Subjects From Baseline at Week 24-1.90 mm Hg
p-value: 0.027695% CI: [-4.7, 0.05]t-test, 1 sided

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026