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

Type 2 Diabetes Mellitus Clinical Trial

Official title:

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

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03115112
• Other study ID #: THR-1442-C-423
• Status: Completed
• Phase: Phase 3
• Start date: October 12, 2017
• Est. completion date: October 31, 2018

Study information

• Verified date: June 2021
• Source: Theracos
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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).

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 386
• Est. completion date: October 31, 2018
• Est. primary completion date: October 31, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

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

Related Conditions & MeSH terms

• Diabetes Mellitus
• Diabetes Mellitus, Type 2
• Type 2 Diabetes Mellitus

Intervention

Drug:
• Bexagliflozin
tablets containing 20 mg bexagliflozin
• Sitagliptin
tablets containing 100 mg sitagliptin
• Placebo for sitagliptin
inactive tablets to match the appearance of sitagliptin tablets
• Placebo for bexagliflozin
inactive tablets to match the appearance of bexagliflozin tablets

Locations

Country	Name	City	State
Czechia	Clinical Research Site 3119	Hodonín
Czechia	Clinical Research Site 3123	Mladá Boleslav
Czechia	Clinical Research Site 3120	Olomouc
Czechia	Clinical Research Site 3112	Praha
Czechia	Clinical Research Site 3122	Prostejov
Hungary	Clinical Research Site 9102	Balatonfüred
Hungary	Clinical Research Site 9101	Balatongyörök
Hungary	Clinical Research Site 9106	Budapest
Hungary	Clinical Research Site 9107	Szeged
Hungary	Clinical Research Site 9105	Zalaegerszeg
Hungary	Clinical Research Site 9103	Zamardi
Japan	Clinical Research Site 6031	Chiba
Japan	Clinical Research Site 6037	Chiba
Japan	Clinical Research Site 6042	Chiba
Japan	Clinical Research Site 6035	Fukuoka
Japan	Clinical Research Site 6040	Fukuoka
Japan	Clinical Research Site 6032	Ibaraki
Japan	Clinical Research Site 6034	Ibaraki
Japan	Clinical Research Site 6039	Ibaraki
Japan	Clinical Research Site 6041	Ibaraki
Japan	Clinical Research Site 6033	Osaka
Japan	Clinical Research Site 6036	Shizuoka
Japan	Clinical Research Site 6038	Tochigi
Poland	Clinical Research Site 7137	Gdansk
Poland	Clinical Research Site 7139	Kraków
Poland	Clinical Research Site 7141	Kraków
Poland	Clinical Research Site 7142	Kraków
Poland	Clinical Research Site 7144	Kraków
Poland	Clinical Research Site 7120	Lublin
Poland	Clinical Research Site 7138	Lublin
Poland	Clinical Research Site 7131	Olsztyn
Poland	Clinical Research Site 7136	Poznan
Poland	Clinical Research Site 7140	Poznan
Poland	Clinical Research Site 7143	Poznan
Poland	Clinical Research Site 7107	Pulawy
Poland	Clinical Research Site 7128	Torun
Spain	Clinical Research Site 9002	Alicante
Spain	Clinical Research Site 9016	Almería
Spain	Clinical Research Site 9005	Alzira
Spain	Clinical Research Site 9013	Barcelona
Spain	Clinical Research Site 9017	Barcelona
Spain	Clinical Research Site 9012	Madrid
Spain	Clinical Research Site 9011	Sevilla
Spain	Clinical Research Site 9014	Sevilla
Spain	Clinical Research Site 9015	Sevilla
Spain	Clinical Research Site 9018	Valencia
United States	Clinical Research Site 1009	Berlin	New Jersey
United States	Clinical Research Site 1271	Chicago	Illinois
United States	Clinical Research Site 1357	Lincoln	California
United States	Clinical Research Site 1358	Long Beach	California
United States	Clinical Research Site 1008	Munroe Falls	Ohio
United States	Clinical Research Site 1031	Port Orange	Florida
United States	Clinical Research Site 1360	San Antonio	Texas
United States	Clinical Research Site 1361	San Dimas	California
United States	Clinical Research Site 1359	Topeka	Kansas
United States	Clinical Research Site 1037	Trenton	New Jersey

Sponsors (1)

Lead Sponsor	Collaborator
Theracos

Countries where clinical trial is conducted

United States,  Czechia,  Hungary,  Japan,  Poland,  Spain, 

Outcome

Type	Measure	Description	Time frame	Safety issue
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.	Baseline to week 24
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	Baseline to week 24
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	Baseline to week 24
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	Baseline to week 24