Exenatide Compared With Twice-Daily Biphasic Insulin Aspart in Patients With Type 2 Diabetes Using Sulfonylurea and Metformin

• ClinicalTrials.gov Identifier: NCT00082407
• Recruitment Status: Completed
• First Posted: May 10, 2004
• Results First Posted: July 31, 2013
• Last Update Posted: April 7, 2015
• Sponsor: AstraZeneca
• Collaborator: Eli Lilly and Company
• Information provided by (Responsible Party): AstraZeneca

Tracking Information

• First Submitted Date: May 6, 2004
• First Posted Date: May 10, 2004
• Results First Submitted Date: July 16, 2009
• Results First Posted Date: July 31, 2013
• Last Update Posted Date: April 7, 2015
• Study Start Date: November 2003
• Actual Primary Completion Date: July 2008 (Final data collection date for primary outcome measure)

Current Primary Outcome Measures (submitted: June 25, 2013)

Change in Glcosylated Hemoglobin (HbA1c) [ Time Frame: baseline, week 52 ]

Change in HbA1c from baseline to week 52

• Original Primary Outcome Measures: Not Provided

Current Secondary Outcome Measures (submitted: June 25, 2013)

• Percentage of Patients Achieving HbA1c <=7% [ Time Frame: 52 weeks ]
  Percentage of patients in each arm who had HbA1c >7% at baseline and had HbA1c <=7% at week 52 (percentage = [number of subjects with HbA1c <=7% at week 52 divided by number of subjects with HbA1c >7% at baseline] * 100%).
• Change in Body Weight [ Time Frame: baseline, week 52 ]
  Change in body weight from baseline to week 52.
• Change in Fasting Serum Glucose [ Time Frame: baseline, week 52 ]
  Change in fasting serum glucose from baseline to week 52
• Change in 7-point Self-monitored Blood Glucose (SMBG) Profile [ Time Frame: baseline, week 52 ]
  Change in 7-point (pre-breakfast, after breakfast, pre-lunch, after lunch, pre-dinner, after dinner, 0300 hours) SMBG profile from baseline to week 52
• Percentage of Patients With Hypoglycemic Events [ Time Frame: 52 weeks ]
  Percentage of patients who experienced at least one episode of hypoglycemia at any point during the 52 week Parent Study (incidence of hypoglycemia = number of patients who experienced at least one episode of hypoglycemia at any point during the 52 week Parent Study divided by the total number of patients who particiapted in the 52 week Parent Study
• Change in Rate of Hypoglycemic Events [ Time Frame: baseline, week 52 ]
  Change in rate of hypoglycemic events per 30 days per patient from baseline to week 52

• Original Secondary Outcome Measures: Not Provided
• Current Other Pre-specified Outcome Measures: Not Provided
• Original Other Pre-specified Outcome Measures: Not Provided

Descriptive Information

• Brief Title: Exenatide Compared With Twice-Daily Biphasic Insulin Aspart in Patients With Type 2 Diabetes Using Sulfonylurea and Metformin
• Official Title: Efficacy of Exenatide (AC2993, Synthetic Exendin-4, LY2148568) Compared With Twice-Daily Biphasic Insulin Aspart in Patients With Type 2 Diabetes Using Sulfonylurea and Metformin
• Brief Summary: This is a Phase 3, multicenter, open-label, comparator-controlled trial comparing the effect of exenatide twice daily to twice daily biphasic insulin aspart on glycemic control, as measured by hemoglobin A1c (HbA1c).
• Detailed Description: Not Provided
• Study Type: Interventional
• Study Phase: Phase 3
• Study Design: Allocation: Randomized; Intervention Model: Parallel Assignment; Masking: None (Open Label); Primary Purpose: Treatment
• Condition: Diabetes Mellitus, Type 2

Intervention

• Drug: exenatide
  subcutaneous injection, twice daily; 5 mcg for 4 weeks followed by 10 mcg for 48 weeks
  Other Name: Byetta
• Drug: biphasic insulin aspart
  subcutaneous injection, twice daily; titration to target blood glucose level
  Other Name: NovoLog

Study Arms

• Experimental: Exenatide Arm
  subcutaneous injection, twice daily; 5 mcg for 4 weeks followed by 10 mcg for 48 weeks
  Intervention: Drug: exenatide
• Active Comparator: Biphasic Insulin Aspart Arm
  subcutaneous injection, twice daily; titration to target blood glucose level
  Intervention: Drug: biphasic insulin aspart

Publications *

• Nauck MA, Duran S, Kim D, Johns D, Northrup J, Festa A, Brodows R, Trautmann M. A comparison of twice-daily exenatide and biphasic insulin aspart in patients with type 2 diabetes who were suboptimally controlled with sulfonylurea and metformin: a non-inferiority study. Diabetologia. 2007 Feb;50(2):259-67. Epub 2006 Dec 8.
• Pencek R, Blickensderfer A, Li Y, Brunell SC, Anderson PW. Exenatide twice daily: analysis of effectiveness and safety data stratified by age, sex, race, duration of diabetes, and body mass index. Postgrad Med. 2012 Jul;124(4):21-32. doi: 10.3810/pgm.2012.07.2567.
• Fineman MS, Mace KF, Diamant M, Darsow T, Cirincione BB, Booker Porter TK, Kinninger LA, Trautmann ME. Clinical relevance of anti-exenatide antibodies: safety, efficacy and cross-reactivity with long-term treatment. Diabetes Obes Metab. 2012 Jun;14(6):546-54. doi: 10.1111/j.1463-1326.2012.01561.x. Epub 2012 Feb 10.

Recruitment Information

• Recruitment Status: Completed
• Actual Enrollment (submitted: June 25, 2013): 505
• Original Enrollment (submitted: June 23, 2005): 526
• Actual Study Completion Date: July 2008
• Actual Primary Completion Date: July 2008 (Final data collection date for primary outcome measure)

Eligibility Criteria

Inclusion Criteria:

• Patients have been treated with a stable dose of the following for at least 3 months prior to screening: 1. >=1500 mg/day immediate-release metformin or extended-release metformin and at least an optimally effective dose for brand of sulfonylurea, or 2. a fixed-dose sulfonylurea/metformin combination therapy with the same sulfonylurea and metformin requirements as for the individual components
• HbA1c between 7.0% and 11.0%, inclusive.
• Patients have a body mass index >25kg/m2 and <40 kg/m2.
• Female patients are not breastfeeding, and female patients of childbearing potential test negative for pregnancy, do not intend to become pregnant during the study, and agree to continue using a reliable method of birth control

Exclusion Criteria:

• Patients are investigator site personnel directly affiliated with the study, or are immediate family of investigator site personnel directly affiliated with the study.
• Patients are employed by Lilly or Amylin.
• Patients have previously, in this or any other study, received exenatide or glucagon-like peptide-1 analogs.
• Patients have participated in an interventional medical, surgical, or pharmaceutical study within 30 days prior to screening. This criterion includes drugs that have not received regulatory approval for any indication at the time of study entry.
• Patients have had greater than three episodes of severe hypoglycemia within 6 months prior to screening.
• Patients have less than 5 years of remission history from any malignancy (other than basal cell or squamous cell skin cancer, in situ carcinomas of the cervix, or in situ prostate cancer).
• Patients have cardiac disease that is Class III or IV, according to the New York Heart Association criteria.
• Patients have a known allergy or hypersensitivity to biphasic insulin aspart, exenatide, or excipients contained in these agents.
• Patients have characteristics contraindicating metformin or sulfonylurea use, according to product-specific label.
• Patients have a history of renal transplantation or are currently receiving renal dialysis or have serum creatinine >=1.5 mg/dL for males and >=1.2 mg/dL for females.
• Patients have obvious clinical signs or symptoms of liver disease, acute or chronic hepatitis, or alanine aminotransferase/serum glutamic pyruvic transaminase greater than three times the upper limit of the reference range.
• Patients have known hemoglobinopathy or chronic anemia.
• Patients have active proliferative retinopathy or macular edema.
• Patients are receiving treatment for gastrointestinal disease with a drug directly affecting gastrointestinal motility, including but not limited to metoclopramide, cisapride, and chronic macrolide antibiotics.
• Patients are receiving chronic (lasting longer than 2 weeks) systemic glucocorticoid therapy (excluding topical and inhaled preparations) or have received such therapy within 2 weeks immediately prior to screening.
• Patients have used any prescription drug to promote weight loss within 3 months prior to screening.
• Patients have been treated for longer than 2 weeks with any of the following excluded medications within 3 months prior to screening: insulin, thiazolidinediones, alpha-glucosidase inhibitors, meglitinides.
• Patients have any other condition (including known drug or alcohol abuse or psychiatric disorder) that precludes them from following and completing the protocol, in the opinion of the investigator.
• Patients fail to satisfy the investigator of suitability to participate for any other reason.

Sex/Gender

• Sexes Eligible for Study: All

• Ages: 30 Years to 75 Years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Contacts: Contact information is only displayed when the study is recruiting subjects
• Listed Location Countries: Croatia, Germany, Greece, Italy, Netherlands, Portugal, Romania, Russian Federation, Slovenia, Spain, Taiwan, United Kingdom

Administrative Information

• NCT Number: NCT00082407
• Other Study ID Numbers: H8O-MC-GWAD
• Has Data Monitoring Committee: No
• U.S. FDA-regulated Product: Not Provided
• IPD Sharing Statement: Not Provided
• Responsible Party: AstraZeneca
• Study Sponsor: AstraZeneca
• Collaborators: Eli Lilly and Company

Investigators

• Study Director: Chief Medical Officer, MD; Eli Lilly and Company

• PRS Account: AstraZeneca
• Verification Date: March 2015