Chronic Kidney Disease Stage 3, Type 2 Diabetes Mellitus
Conditions
Brief summary
Primary Objective: To demonstrate the superiority of Sotagliflozin 200 milligrams (mg) and Sotagliflozin 400 mg versus placebo on HbA1c reduction at 26 Weeks in participants with Type 2 diabetes who have inadequate glycemic control and moderate renal impairment. Secondary Objectives: * To assess the effects of Sotagliflozin 200 mg and 400 mg versus placebo with respect to additional measures of glycemic control, blood pressure, and body weight. * To evaluate the safety of Sotagliflozin 200 mg and 400 mg versus placebo.
Detailed description
The study duration is up to 60 weeks including 4 weeks prior to randomization, 52 weeks of randomized treatment, and a visit 4 weeks after completion of the randomized treatment period.
Interventions
Placebo tablet (identical to sotagliflozin 200 mg in appearance), orally once daily. Route of administration: Oral
Sotagliflozin 200 mg, tablet, orally once daily. Route of administration: Oral
Sponsors
Study design
Eligibility
Inclusion criteria
: * Participants with Type 2 Diabetes (drug-naïve or on antidiabetic therapy) and documented moderate renal insufficiency defined by an estimated glomerular filtration rate (eGFR) (based on the 4 variable Modification of Diet in Renal Disease (MDRD) equation) of ≥30 and \<60 milliliter per minute (mL/min)/1.73 meter square (m\^2) (chronic kidney disease \[CKD\] 3A, 3B). * Participants has given written informed consent to participate in the study in accordance with local regulations.
Exclusion criteria
* Hemoglobin A1c (HbA1c) of \<7.0% or \>11.0%. * Type 1 diabetes. * Women of childbearing potential (WOCBP) not willing to use highly effective method(s) of birth control during the study treatment period and the follow-up period, or who are unwilling or unable to be tested for pregnancy during the study. * Treatment with a sodium-glucose cotransporter type 2 (SGLT2) inhibitor (Canagliflozin, Dapagliflozin, Empagliflozin) during the last 12 months. * Uncontrolled high blood pressure. * Participants with severe anemia, severe cardiovascular (including congestive heart failure New York Heart Association IV), respiratory, hepatic, neurological, psychiatric, or active malignant tumor or other major systemic disease or patients with short life expectancy that, according to the Investigator, will preclude their safe participation in this study, or will make implementation of the protocol or interpretation of the study results difficult. * Lower extremity complications (such as skin ulcers, infection, osteomyelitis and gangrene) identified during the Screening period, and still requiring treatment at Randomization. The above information is not intended to contain all considerations relevant to a participant's potential participation in a clinical trial.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in HbA1c at Week 26 | Baseline to Week 26 | An Analysis of covariance (ANCOVA) model was used for analysis. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Fasting Plasma Glucose (FPG) at Week 26 | Baseline to Week 26 | An ANCOVA model was used for analysis. |
| Change From Baseline in SBP for Participants With Baseline SBP ≥130 mmHg at Week 12 | Baseline to Week 12 | An ANCOVA model was used for analysis. |
| Change From Baseline in SBP at Week 12 for All Participants | Baseline to Week 12 | An ANCOVA model was used for analysis. |
| Change From Baseline in Body Weight at Week 26 | Baseline to Week 26 | An ANCOVA model was used for analysis. |
| Percentage of Participants With HbA1c <6.5% at Week 26 | Week 26 | — |
| Percentage of Participants With HbA1c <7.0% at Week 26 | Week 26 | — |
| Percentage of Participants With Treatment-emergent Adverse Events (TEAEs) | Up to 60 weeks | — |
| Percentage Change From Baseline in the Urine Albumin: Creatinine Ratio (UACR) at Week 26 in Participants With Baseline UACR >30 Milligrams Per Gram (mg/g) | Baseline to Week 26 | An ANCOVA model was used for analysis. No Measure of Dispersion was pre-specified to be calculated. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants With Hypoglycemic Events | Up to 60 weeks | Percentage of participants with hypoglycemic events are reported for the following 3 categories: Any hypoglycemia (as reported in the Electronic Case Report Form); Documented symptomatic hypoglycemia \[typical symptoms of hypoglycemia (increased sweating, nervousness, asthenia/weakness, tremor, dizziness, increased appetite, palpitations, headache, sleep disorder, confusion, seizures, unconsciousness, and/or coma) and plasma glucose ≤ 70 mg/dL (3.9 mmol/L)\]; Severe \[an event requiring assistance of another person to actively administer carbohydrate, glucagon, intravenous glucose or other resuscitative actions\] or documented symptomatic hypoglycemia \[typical symptoms of hypoglycemia and plasma glucose ≤ 70 mg/dL\]. |
Countries
Argentina, Brazil, Canada, Colombia, Germany, Hungary, Israel, Italy, Mexico, Poland, Romania, Russia, South Africa, Spain, Ukraine, United States
Participant flow
Recruitment details
Participants took part in the study at 166 investigative sites in the United States, Argentina, Brazil, Canada, Colombia, Germany, Hungary, Israel, Italy, Mexico, Poland, Romania, Russian Federation, South Africa, Spain, and Ukraine from 16 August 2017 to 25 October 2019.
Pre-assignment details
Participants with a diagnosis of Type 2 Diabetes Mellitus were enrolled in 1 of 3 treatment groups: Placebo or Sotagliflozin 200 milligrams (mg) or Sotagliflozin 400 mg. Participants were randomly assigned in the ratio of 1:1:1 to these reporting groups.
Participants by arm
| Arm | Count |
|---|---|
| Placebo Following a 2-week run-in period, participants received two placebo tablets (identical to sotagliflozin 200 mg in appearance), orally once daily, before the first meal of the day for up to 54 weeks. | 260 |
| Sotagliflozin 200 mg Following a 2-week run-in period, participants received two tablets, 1 sotagliflozin 200 mg tablet and 1 placebo tablet (identical to sotagliflozin 200 mg in appearance), orally once daily, before the first meal of the day for up to 58 weeks. | 263 |
| Sotagliflozin 400 mg Following a 2-week run-in period, participants received sotagliflozin 400 mg, administered as two 200 mg sotagliflozin tablets, orally once daily, before the first meal of the day for up to 60 weeks. | 264 |
| Total | 787 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Adverse Event | 8 | 6 | 9 |
| Overall Study | At the Participant's own Request | 18 | 10 | 15 |
| Overall Study | Lost to Follow-up | 5 | 1 | 4 |
| Overall Study | Poor Compliance to Protocol | 0 | 2 | 3 |
| Overall Study | Reason not Specified | 4 | 4 | 1 |
| Overall Study | Study Terminated by Sponsor | 1 | 0 | 0 |
Baseline characteristics
| Characteristic | Placebo | Sotagliflozin 200 mg | Sotagliflozin 400 mg | Total |
|---|---|---|---|---|
| Age, Continuous | 69.3 years STANDARD_DEVIATION 8.1 | 69.6 years STANDARD_DEVIATION 7.5 | 69.5 years STANDARD_DEVIATION 8.2 | 69.5 years STANDARD_DEVIATION 7.9 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 67 Participants | 67 Participants | 64 Participants | 198 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 193 Participants | 196 Participants | 200 Participants | 589 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Hemoglobin A1c (HbA1c) | 8.33 percentage of HbA1c STANDARD_DEVIATION 1 | 8.33 percentage of HbA1c STANDARD_DEVIATION 0.9 | 8.31 percentage of HbA1c STANDARD_DEVIATION 0.94 | 8.32 percentage of HbA1c STANDARD_DEVIATION 0.95 |
| Race (NIH/OMB) American Indian or Alaska Native | 15 Participants | 9 Participants | 20 Participants | 44 Participants |
| Race (NIH/OMB) Asian | 5 Participants | 7 Participants | 8 Participants | 20 Participants |
| Race (NIH/OMB) Black or African American | 12 Participants | 14 Participants | 15 Participants | 41 Participants |
| Race (NIH/OMB) More than one race | 3 Participants | 0 Participants | 3 Participants | 6 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 1 Participants | 1 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 4 Participants | 1 Participants | 3 Participants | 8 Participants |
| Race (NIH/OMB) White | 220 Participants | 231 Participants | 215 Participants | 666 Participants |
| Region of Enrollment Argentina | 8 participants | 8 participants | 8 participants | 24 participants |
| Region of Enrollment Brazil | 22 participants | 22 participants | 22 participants | 66 participants |
| Region of Enrollment Canada | 11 participants | 18 participants | 12 participants | 41 participants |
| Region of Enrollment Colombia | 12 participants | 6 participants | 14 participants | 32 participants |
| Region of Enrollment Germany | 0 participants | 5 participants | 2 participants | 7 participants |
| Region of Enrollment Hungary | 21 participants | 23 participants | 13 participants | 57 participants |
| Region of Enrollment Israel | 23 participants | 17 participants | 16 participants | 56 participants |
| Region of Enrollment Italy | 5 participants | 6 participants | 8 participants | 19 participants |
| Region of Enrollment Mexico | 14 participants | 13 participants | 7 participants | 34 participants |
| Region of Enrollment Poland | 29 participants | 23 participants | 32 participants | 84 participants |
| Region of Enrollment Romania | 6 participants | 14 participants | 13 participants | 33 participants |
| Region of Enrollment Russia | 15 participants | 10 participants | 14 participants | 39 participants |
| Region of Enrollment South Africa | 7 participants | 3 participants | 12 participants | 22 participants |
| Region of Enrollment Spain | 9 participants | 10 participants | 15 participants | 34 participants |
| Region of Enrollment Ukraine | 12 participants | 13 participants | 14 participants | 39 participants |
| Region of Enrollment United States | 66 participants | 72 participants | 62 participants | 200 participants |
| Sex: Female, Male Female | 111 Participants | 120 Participants | 112 Participants | 343 Participants |
| Sex: Female, Male Male | 149 Participants | 143 Participants | 152 Participants | 444 Participants |
| Systolic Blood Pressure (SBP) | 140.59 millimeter of mercury (mmHg) STANDARD_DEVIATION 14.59 | 140.31 millimeter of mercury (mmHg) STANDARD_DEVIATION 15.15 | 141.71 millimeter of mercury (mmHg) STANDARD_DEVIATION 15.01 | 140.87 millimeter of mercury (mmHg) STANDARD_DEVIATION 14.91 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 3 / 260 | 2 / 267 | 5 / 260 |
| other Total, other adverse events | 80 / 260 | 72 / 267 | 77 / 260 |
| serious Total, serious adverse events | 48 / 260 | 43 / 267 | 44 / 260 |
Outcome results
Change From Baseline in HbA1c at Week 26
An Analysis of covariance (ANCOVA) model was used for analysis.
Time frame: Baseline to Week 26
Population: Intent-to-treat (ITT) population included all randomized participants or participants analyzed according to their randomized treatment. Missing data was imputed using control-based copy reference multiple imputation under the missing not at random framework.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in HbA1c at Week 26 | -0.22 percentage of HbA1c | Standard Error 0.061 |
| Sotagliflozin 200 mg | Change From Baseline in HbA1c at Week 26 | -0.32 percentage of HbA1c | Standard Error 0.06 |
| Sotagliflozin 400 mg | Change From Baseline in HbA1c at Week 26 | -0.46 percentage of HbA1c | Standard Error 0.06 |
Change From Baseline in Body Weight at Week 26
An ANCOVA model was used for analysis.
Time frame: Baseline to Week 26
Population: ITT population included all randomized participants or participants analyzed according to their randomized treatment. Missing data was imputed using the retrieved dropouts \& washout imputation method.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in Body Weight at Week 26 | -0.38 kilogram (kg) | Standard Error 0.262 |
| Sotagliflozin 200 mg | Change From Baseline in Body Weight at Week 26 | -1.66 kilogram (kg) | Standard Error 0.246 |
| Sotagliflozin 400 mg | Change From Baseline in Body Weight at Week 26 | -1.20 kilogram (kg) | Standard Error 0.257 |
Change From Baseline in Fasting Plasma Glucose (FPG) at Week 26
An ANCOVA model was used for analysis.
Time frame: Baseline to Week 26
Population: ITT population included all randomized participants or participants analyzed according to their randomized treatment. Missing data was imputed using the retrieved dropouts \& washout imputation method.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in Fasting Plasma Glucose (FPG) at Week 26 | -0.374 millimole per liter (mmol/L) | Standard Error 0.1949 |
| Sotagliflozin 200 mg | Change From Baseline in Fasting Plasma Glucose (FPG) at Week 26 | -0.961 millimole per liter (mmol/L) | Standard Error 0.1715 |
| Sotagliflozin 400 mg | Change From Baseline in Fasting Plasma Glucose (FPG) at Week 26 | -0.852 millimole per liter (mmol/L) | Standard Error 0.1668 |
Change From Baseline in SBP at Week 12 for All Participants
An ANCOVA model was used for analysis.
Time frame: Baseline to Week 12
Population: ITT population included all randomized participants or participants analyzed according to their randomized treatment. Missing data was imputed using the retrieved dropouts \& washout imputation method.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in SBP at Week 12 for All Participants | -3.31 mmHg | Standard Error 1.037 |
| Sotagliflozin 200 mg | Change From Baseline in SBP at Week 12 for All Participants | -4.91 mmHg | Standard Error 1.01 |
| Sotagliflozin 400 mg | Change From Baseline in SBP at Week 12 for All Participants | -4.94 mmHg | Standard Error 0.983 |
Change From Baseline in SBP for Participants With Baseline SBP ≥130 mmHg at Week 12
An ANCOVA model was used for analysis.
Time frame: Baseline to Week 12
Population: Analysis population included participants with baseline SBP ≥130 mmHg in ITT population where, ITT population included all randomized participants or participants analyzed according to their randomized treatment. Missing data was imputed using the retrieved dropouts \& washout imputation method.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in SBP for Participants With Baseline SBP ≥130 mmHg at Week 12 | -5.18 mmHg | Standard Error 1.462 |
| Sotagliflozin 200 mg | Change From Baseline in SBP for Participants With Baseline SBP ≥130 mmHg at Week 12 | -7.46 mmHg | Standard Error 1.597 |
| Sotagliflozin 400 mg | Change From Baseline in SBP for Participants With Baseline SBP ≥130 mmHg at Week 12 | -7.71 mmHg | Standard Error 1.247 |
Percentage Change From Baseline in the Urine Albumin: Creatinine Ratio (UACR) at Week 26 in Participants With Baseline UACR >30 Milligrams Per Gram (mg/g)
An ANCOVA model was used for analysis. No Measure of Dispersion was pre-specified to be calculated.
Time frame: Baseline to Week 26
Population: Analysis population included participants with baseline UACR \>30 mg/g in ITT population where, ITT population included all randomized participants or participants analyzed according to their randomized treatment. Missing data was imputed using control-based copy reference multiple imputation under the missing not at random framework.
| Arm | Measure | Value (GEOMETRIC_MEAN) |
|---|---|---|
| Placebo | Percentage Change From Baseline in the Urine Albumin: Creatinine Ratio (UACR) at Week 26 in Participants With Baseline UACR >30 Milligrams Per Gram (mg/g) | -18.71 percent change |
| Sotagliflozin 200 mg | Percentage Change From Baseline in the Urine Albumin: Creatinine Ratio (UACR) at Week 26 in Participants With Baseline UACR >30 Milligrams Per Gram (mg/g) | -43.68 percent change |
| Sotagliflozin 400 mg | Percentage Change From Baseline in the Urine Albumin: Creatinine Ratio (UACR) at Week 26 in Participants With Baseline UACR >30 Milligrams Per Gram (mg/g) | -48.12 percent change |
Percentage of Participants With HbA1c <6.5% at Week 26
Time frame: Week 26
Population: ITT population included all randomized participants or participants analyzed according to their randomized treatment.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants With HbA1c <6.5% at Week 26 | 4.2 percentage of participants |
| Sotagliflozin 200 mg | Percentage of Participants With HbA1c <6.5% at Week 26 | 5.7 percentage of participants |
| Sotagliflozin 400 mg | Percentage of Participants With HbA1c <6.5% at Week 26 | 5.7 percentage of participants |
Percentage of Participants With HbA1c <7.0% at Week 26
Time frame: Week 26
Population: ITT population included all randomized participants or participants analyzed according to their randomized treatment.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants With HbA1c <7.0% at Week 26 | 13.5 percentage of participants |
| Sotagliflozin 200 mg | Percentage of Participants With HbA1c <7.0% at Week 26 | 19.4 percentage of participants |
| Sotagliflozin 400 mg | Percentage of Participants With HbA1c <7.0% at Week 26 | 20.8 percentage of participants |
Percentage of Participants With Treatment-emergent Adverse Events (TEAEs)
Time frame: Up to 60 weeks
Population: Safety population included all participants who received at least 1 dose of study drug analyzed according to the treatment actually received.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants With Treatment-emergent Adverse Events (TEAEs) | 78.1 percentage of participants |
| Sotagliflozin 200 mg | Percentage of Participants With Treatment-emergent Adverse Events (TEAEs) | 76.8 percentage of participants |
| Sotagliflozin 400 mg | Percentage of Participants With Treatment-emergent Adverse Events (TEAEs) | 74.2 percentage of participants |
Percentage of Participants With Hypoglycemic Events
Percentage of participants with hypoglycemic events are reported for the following 3 categories: Any hypoglycemia (as reported in the Electronic Case Report Form); Documented symptomatic hypoglycemia \[typical symptoms of hypoglycemia (increased sweating, nervousness, asthenia/weakness, tremor, dizziness, increased appetite, palpitations, headache, sleep disorder, confusion, seizures, unconsciousness, and/or coma) and plasma glucose ≤ 70 mg/dL (3.9 mmol/L)\]; Severe \[an event requiring assistance of another person to actively administer carbohydrate, glucagon, intravenous glucose or other resuscitative actions\] or documented symptomatic hypoglycemia \[typical symptoms of hypoglycemia and plasma glucose ≤ 70 mg/dL\].
Time frame: Up to 60 weeks
Population: Safety population included all participants who received at least 1 dose of study drug analyzed according to the treatment actually received.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Placebo | Percentage of Participants With Hypoglycemic Events | Documented symptomatic hypoglycemia | 26.9 percentage of participants |
| Placebo | Percentage of Participants With Hypoglycemic Events | Any hypoglycemia | 38.1 percentage of participants |
| Placebo | Percentage of Participants With Hypoglycemic Events | Severe or documented symptomatic hypoglycemia | 26.9 percentage of participants |
| Sotagliflozin 200 mg | Percentage of Participants With Hypoglycemic Events | Documented symptomatic hypoglycemia | 29.6 percentage of participants |
| Sotagliflozin 200 mg | Percentage of Participants With Hypoglycemic Events | Any hypoglycemia | 41.9 percentage of participants |
| Sotagliflozin 200 mg | Percentage of Participants With Hypoglycemic Events | Severe or documented symptomatic hypoglycemia | 29.6 percentage of participants |
| Sotagliflozin 400 mg | Percentage of Participants With Hypoglycemic Events | Any hypoglycemia | 35.4 percentage of participants |
| Sotagliflozin 400 mg | Percentage of Participants With Hypoglycemic Events | Severe or documented symptomatic hypoglycemia | 22.3 percentage of participants |
| Sotagliflozin 400 mg | Percentage of Participants With Hypoglycemic Events | Documented symptomatic hypoglycemia | 22.3 percentage of participants |