Received: 12 October 2016

Revised: 20 December 2016

Accepted: 29 December 2016

DOI 10.1111/dom.12875

BRIEF REPORT

Efficacy and safety of fixed-dose combination therapy, alogliptin plus metformin, in Asian patients with type 2 diabetes: A phase 3 trial Linong Ji MD1

| Ling Li MD2 | Jian Kuang MD3 | Tao Yang MD4 |

Dong-Jun Kim MD, PhD5 | Azidah A. Kadir MD6 | Chien-Ning Huang MD7 | Douglas Lee MD8 1 Department of Endocrinology, Peking University People’s Hospital, Beijing, China

This study evaluated the efficacy and safety of 26 weeks of twice-daily (BID) alogliptin + met-

2

formin fixed-dose combination (FDC) therapy in Asian patients with type 2 diabetes. Patients

Department of Endocrinology, Shengjing Hospital of China Medical University, Shenyang, China 3 Department of Endocrinology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China 4

Department of Endocrinology, Jiangsu Province Hospital, Nanjing, China 5

Department of Internal Medicine, Ilsan Paik Hospital, Inje University, Goyang, Korea 6

Department of Family Medicine, Universiti Sains Malaysia, Kubang Kerian, Malaysia 7

Department of Endocrinology and Metabolism, Chung Shang Medical University Hospital, Taichung City, Taiwan, China

aged 18 to 75 years with hemoglobin A1c (HbA1c) of 7.5% to 10.0% after ≥2 months of diet and exercise and a 4-week placebo run-in were enrolled. Eligible patients were randomized (1:1:1:1) to placebo, alogliptin 12.5 mg BID, metformin 500 mg BID or alogliptin 12.5 mg plus metformin 500 mg FDC BID. The primary endpoint was change in HbA1c from baseline to end of treatment (Week 26). In total, 647 patients were randomized. The least-squares mean change in HbA1c from baseline to Week 26 was −0.19% with placebo, −0.86% with alogliptin, −1.04% with metformin and −1.53% with alogliptin + metformin FDC. Alogliptin + metformin FDC was significantly more effective (P < .0001) in lowering HbA1c than either alogliptin or metformin alone. The safety profile of alogliptin + metformin FDC was similar to that of the individual components alogliptin and metformin. The study demonstrated that treatment with alogliptin + metformin FDC BID resulted in better glycaemic control than either monotherapy and was well tolerated in Asian patients with type 2 diabetes.

8

Takeda Development Centre Europe, Ltd, London, United Kingdom Correspondence Linong Ji, Department of Endocrinology, People’s Hospital of Peking University, Xicheng District, Beijing 100044, China. Email: [email protected]

KEYWORDS

alogliptin, DPP-IV inhibitor, glycaemic control, metformin, type 2 diabetes

Funding information This study was sponsored by Takeda Pharmaceutical Company Limited.

1 | I N T RO D UC T I O N

These adverse events (AEs) often negatively affect treatment adherence and/or long-term use. Therefore, there is a need for effective,

The prevalence of diabetes mellitus and suboptimal achievement of

long-term glycaemic control regimens that can be administered safely.

glycaemic control is increasing in Asian populations.1–3 Evidence

Alogliptin is a potent, highly selective, orally available dipeptidyl

shows that there may be differences in the pathophysiology of type

peptidase-4 (DPP-4) inhibitor. Since 2013, alogliptin has been availa-

2 diabetes across ethnic subgroups, with Asian vs non-Asian patients

ble in the USA and the European Union as monotherapy and as a

exhibiting a propensity for lower body mass index, a higher proportion

fixed-dose combination (FDC) with metformin. The FDC formulation

4,5

Although

was developed to improve convenience and, ultimately, patient

pharmacologic agents are available to patients with type 2 diabetes

adherence. Mechanistically, inhibition of DPP-4 activity leads to an

who fail to achieve sufficient glycaemic control through diet and exer-

increase in hormone glucagon-like peptide 1 levels, which in turn sti-

cise, many of these agents may cause hypoglycaemia or weight gain.6,7

mulates glucose-dependent insulin secretion from pancreatic β-cells.8

of visceral fat and predominant insulin secretory defects.

754

© 2017 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

wileyonlinelibrary.com/journal/dom

Diabetes Obes Metab. 2017;19:754–758.

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

755

JI ET AL.

This mechanism of achieving glucose homeostasis is distinct from

Changes from baseline in HbA1c and FPG (least-squares

that of metformin, which is a biguanide that suppresses hepatic glu-

[LS] means) were summarized at each time point using descriptive

cose release and also induces weight loss via reduced calorie intake.9

statistics. The incidences of hyperglycaemic rescue (for FPG ≥ 275

Given the complementary mechanisms of action of alogliptin and

mg/dL [≥15.27 mmol/L] before Week 12 or HbA1c ≥ 8.5% and

metformin, and the potential for incrementally improving glycaemic

≤0.5% reduction in HbA1c between Week 12 and the final visit),

control without exacerbating safety events, there has been interest in

marked hyperglycaemia (FPG > 200 mg/dL [11.1 mmol/L]) and clini-

the use of this FDC in patients with type 2 diabetes. Phase 3 clinical

cal response were also summarized (frequency and percentage) by

trials in Asian patients have shown that concomitant administration

treatment group. Continuous secondary endpoints were analysed

of alogliptin and metformin is effective and has a safety profile similar

using an appropriate statistical model with the Model 1 variables. The

10,11

The current phase 3 study

analysis was carried out using a Cox proportional hazard model, with

was designed to evaluate the efficacy and safety of alogliptin

treatment as an effect, country as a stratification factor and baseline

12.5 mg plus metformin 500 mg FDC BID vs alogliptin or metformin

HbA1c as a covariate. For each efficacy variable, the corresponding

alone in Asian patients with type 2 diabetes who are inadequately

baseline value for that variable was modeled as a covariate in place

controlled with diet and exercise.

of baseline HbA1c. All secondary variables were analysed at the 2-

to that of the individual components.

sided significance level of 5%. Treatment-emergent AEs (including all events, irrespective of

2 | MATERIALS AND METHODS

treatment relationship and treatment-related AEs), clinical laboratory changes and hypoglycaemic episodes were summarized.

This was a phase 3, randomized, double-blind, placebo-controlled, multicentre study that was conducted at 59 sites in China, Malaysia, Republic of Korea (South Korea) and Taiwan. It was conducted in

3 | RE SU LT S

compliance with the study protocol, the ethical principles originating in the Declaration of Helsinki and the International Conference on

Of 1258 screened patients, 647 were randomized to placebo

Harmonisation of Tripartite Guidelines for Good Clinical Practice. All

(n = 163), alogliptin (n = 163), metformin (n = 162) or alogliptin +

patients

metformin FDC (n = 159) and were included in the efficacy and

provided

written

informed

consent

prior

to

study

procedures.

safety populations (Figure S1, File S1). Demographic and clinical char-

Patients aged 18 to 75 years were eligible if they had an histori-

acteristics for the randomized population were similar between study

cal diagnosis of type 2 diabetes for which glycaemic control was inad-

groups (Table S1, File S1). Of the 647 treated patients, 511 (n = 104,

equate (ie, HbA1c of 7.5%-10.0% after at least 2 months of diet and

placebo; n = 126, alogliptin; n = 135, metformin; n = 146, alogliptin +

exercise prior to the screening period). Key exclusion criteria included

metformin FDC) completed the study. The most common reason for

a significant history of hepatic and cardiovascular disease.

study discontinuation was lack of efficacy (n = 86 [64.2%] all groups).

The study consisted of 4 periods: screening (≤2 weeks), placebo run-in (4 weeks), treatment (26 weeks) and follow-up (2 weeks). Eligible patients had HbA1c of 7.5% to 10.0% and fasting plasma glucose

3.1 | Efficacy

(FPG) ≤ 275 mg/dL (15.27 mmol/L) at the Week −1 visit of the pla-

The LS mean change in HbA1c from baseline to end of treatment

cebo run-in (1 week prior to the treatment phase). After stratifying

(Week 26) was −0.19% with placebo, −0.86% with alogliptin, −1.04%

patients by screening HbA1c (

Efficacy and safety of fixed-dose combination therapy, alogliptin plus metformin, in Asian patients with type 2 diabetes: A phase 3 trial.

This study evaluated the efficacy and safety of 26 weeks of twice-daily (BID) alogliptin + metformin fixed-dose combination (FDC) therapy in Asian pat...
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