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The ORIGIN Trial (Outcome Reduction With Initial Glargine Intervention) (ORIGIN)

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ClinicalTrials.gov Identifier: NCT00069784
Recruitment Status : Completed
First Posted : October 6, 2003
Results First Posted : January 25, 2013
Last Update Posted : January 31, 2013
Sponsor:
Collaborator:
Population Health Research Institute
Information provided by (Responsible Party):
Sanofi

Study Type: Interventional
Study Design: Allocation: Randomized;   Intervention Model: Factorial Assignment;   Masking: None (Open Label);   Primary Purpose: Treatment
Condition: Diabetes Mellitus, Non-Insulin-Dependent
Interventions: Drug: insulin glargine (HOE901)
Drug: omega-3 polyunsaturated fatty acids (PUFA)
Drug: placebo
Device: reusable pen device for insulin injection

  Participant Flow

Recruitment Details
Key information relevant to the recruitment process for the overall study, such as dates of the recruitment period and locations
This study was conducted at 575 sites in 40 countries between August 22, 2003 and December 19, 2011. Three sites were closed and data from these sites were not analyzed following site audits and in compliance with rulings from national health authorities.

Pre-Assignment Details
Significant events and approaches for the overall study following participant enrollment, but prior to group assignment
The purpose of the factorial design was to efficiently answer two independent scientifically worthwhile questions regarding insulin glargine and omega-3 fatty acids within the context of a single clinical trial. Sample size was determined based on the insulin glargine study objective. Results reported below are those of the insulin glargine study.

Reporting Groups
  Description
Insulin Glargine Treatment with Insulin Glargine with or without omega-3 polyunsaturated fatty acids
Standard Care Standard care with or without omega-3 polyunsaturated fatty acids

Participant Flow:   Overall Study
    Insulin Glargine   Standard Care
STARTED   6264 [1]   6273 [1] 
Safety Population (Treated)   6231 [2]   6273 [3] 
COMPLETED   5052 [4]   6273 [5] 
NOT COMPLETED   1212   0 
Adverse Event                105                0 
Withdrawal by Subject                1090                0 
Other                17                0 
[1] randomized participants = intent-to-treat (ITT) population
[2] randomized patients who received at least one dose of insulin glargine
[3] patients randomized to standard care arm
[4] completed study treatment
[5] not applicable (no treatment)



  Baseline Characteristics

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
No text entered.

Reporting Groups
  Description
Insulin Glargine Treatment with Insulin Glargine with or without omega-3 polyunsaturated fatty acids
Standard Care Standard care with or without omega-3 polyunsaturated fatty acids
Total Total of all reporting groups

Baseline Measures
   Insulin Glargine   Standard Care   Total 
Overall Participants Analyzed 
[Units: Participants]
 		 6264   6273   12537 
Age 
[Units: Years]
Mean (Standard Deviation) 		 63.5  (7.8)   63.5  (7.9)   63.5  (7.8) 
Gender, Customized 
[Units: Participants]
 		     
Male   4181   3969   8150 
Female   2082   2304   4386 
Missing value   1   0   1 
Baseline Weight [1] 
[Units: Kg]
Mean (Standard Deviation) 		 83.33  (16.77)   83.13  (17.28)   83.23  (17.03) 
[1] Due to missing values, N=6256 for insulin glargine and N=6271 for standard care.
Baseline Body Mass Index [1] 
[Units: Kg/m²]
Mean (Standard Deviation) 		 29.77  (5.17)   29.88  (5.33)   29.82  (5.25) 
[1] Due to missing values, N=6251 for insulin glargine and N=6270 for standard care.
Any previous cardiovascular event 
[Units: Participants]
 		     
No   2552   2607   5159 
Yes   3712   3666   7378 
Diabetes diagnosis at time of screening [1] 
[Units: Participants]
 		     
IFG and/or IGT   735   717   1452 
Newly diagnosed diabetic   365   395   760 
Established diabetes with no OAD treatment   1414   1467   2881 
Established diabetes with one OAD treatment   3748   3692   7440 
Unclear diabetes status   2   2   4 
[1]

IFG = Impaired Fasting Glucose defined as a Postprandial Plasma Glucose (PPG) value ≥140 and <200 mg/dL (ie, ≥7.8 and <11.1 mmol/L), with a Fasting Plasma Glucose (FPG) <126 mg/dL (7.0 mmol/L)

IGT = Impaired Glucose Tolerance defined as an FPG ≥110 and <126 mg/dL (≥6.1 and <7 mmol/L), without diabetes mellitus (PPG must be <200 mg/dL [11.1 mmol/L])

OAD = oral antidiabetic drug
Duration of diabetes for established diabetes patients [1] 
[Units: Years]
Median (Inter-Quartile Range) 		 3.50 
 (1.50 to 7.50)  		 3.50 
 (1.50 to 7.50)  		 3.50 
 (1.50 to 7.50) 
[1] Population of patients with established diabetes. Due to missing values, N=5148 for insulin glargine and N=5141 for standard care.
Glycated Hemoglobin A1c (HbA1c) [1] 
[Units: Percent]
Median (Inter-Quartile Range) 		 6.41 
 (5.81 to 7.18)  		 6.40 
 (5.81 to 7.16)  		 6.40 
 (5.81 to 7.18) 
[1] Due to missing values, N=6175 for insulin glargine and N=6189 for standard care.
Fasting Plasma Glucose [1] 
[Units: mmol/L]
Median (Inter-Quartile Range) 		 6.94 
 (6.05 to 8.20)  		 6.90 
 (6.00 to 8.20)  		 6.94 
 (6.05 to 8.20) 
[1] Due to missing values, N=6248 for insulin glargine and N=6266 for standard care.


  Outcome Measures

1.  Primary:   Composite of the First Occurrence of Cardiovascular (CV) Death, Nonfatal Myocardial Infarction (MI) or Nonfatal Stroke   [ Time Frame: from randomization until study cut-off date (median duration of follow-up: 6.2 years) ]
  Show Outcome Measure 1

2.  Primary:   Composite of the First Occurrence of Cardiovascular (CV) Death, Nonfatal Myocardial Infarction (MI), Nonfatal Stroke, Revascularization Procedure or Hospitalization for Heart Failure (HF)   [ Time Frame: from randomization until study cut-off date (median duration of follow-up: 6.2 years) ]
  Show Outcome Measure 2

3.  Secondary:   Total Mortality (All Causes)   [ Time Frame: from randomization until study cut-off date (median duration of follow-up: 6.2 years) ]
  Show Outcome Measure 3

4.  Secondary:   Composite Diabetic Microvascular Outcome (Kidney or Eye Disease)   [ Time Frame: from randomization until study cut-off date (median duration of follow-up: 6.2 years) ]
  Hide Outcome Measure 4

Measure Type Secondary
Measure Title Composite Diabetic Microvascular Outcome (Kidney or Eye Disease)
Measure Description

The composite outcome used to analyze microvascular disease progression contained components of clinical events:

  • the occurrence of laser surgery or vitrectomy for diabetic retinopathy (DR);
  • the development of blindness due to DR;
  • the occurrence of renal death or renal replacement therapy; as well as the following laboratory-based events:
  • doubling of serum creatinine; or
  • progression of albuminuria (from none to microalbuminuria [at least 30 mg/g creatinine], to macroalbuminuria [at least 300 mg/g creatinine]).
Time Frame from randomization until study cut-off date (median duration of follow-up: 6.2 years)  

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.

The analysis was based on the intent-to-treat (ITT) population i.e. all randomized participants.

For the endpoint's composition, the numbers only summarize the event when it was the first occurrence of the endpoint. A participant is counted only once within a category. The same participant may appear in different categories.

Reporting Groups
  Description
Insulin Glargine Treatment with Insulin Glargine with or without omega-3 polyunsaturated fatty acids
Standard Care Standard care with or without omega-3 polyunsaturated fatty acids

Measured Values
   Insulin Glargine   Standard Care 
Participants Analyzed 
[Units: Participants]
 		 6264   6273 
Composite Diabetic Microvascular Outcome (Kidney or Eye Disease) 
[Units: Participants]
 		   
Participants with a composite endpoint   1323   1363 
Endpoint's composition: vitrectomy   24   25 
Endpoint's composition: laser therapy for DR   57   67 
Endpoint's composition: dialysis   18   28 
Endpoint's composition: renal transplant   0   0 
Endpoint's composition: serum creatinine doubled   82   88 
Endpoint's composition: death due to renal failure   4   3 
Endpoint's composition: albuminuria progression   1153   1171 


Statistical Analysis 1 for Composite Diabetic Microvascular Outcome (Kidney or Eye Disease)
Groups [1] All groups
Statistical Test Type [2] Superiority or Other
Cox Proportional Hazard [3] 0.970
95% Confidence Interval 0.900 to 1.047
[1] Additional details about the analysis, such as null hypothesis and power calculation:
  No text entered.
[2] Details of power calculation, definition of non-inferiority margin, and other key parameters:
  No text entered.
[3] Other relevant estimation information:
  Hazard ratio (glargine/standard care) estimated by Cox regression model with treatment (glargine, standard care) as factor, with double-blind treatment (omega-3 PUFA, placebo), baseline diabetes diagnosis and previous CV event as covariates.



5.  Secondary:   Incidence of Development of Type 2 Diabetes Mellitus in Participants With IGT and/or IFG   [ Time Frame: from randomization until the last follow-up visit or last OGTT (median duration of follow-up: 6.2 years) ]
  Show Outcome Measure 5

6.  Other Pre-specified:   Number of Patients With Various Types of Symptomatic Hypoglycemia Events   [ Time Frame: on-treatment period (median duration of follow-up: 6.2 years) ]
  Show Outcome Measure 6

7.  Other Pre-specified:   Number of Patients With First Occurrence of Any Type of Cancer   [ Time Frame: from randomization until study cut-off date (median duration of follow-up: 6.2 years) ]
  Show Outcome Measure 7


  Serious Adverse Events


  Other Adverse Events


  Limitations and Caveats

Limitations of the study, such as early termination leading to small numbers of participants analyzed and technical problems with measurement leading to unreliable or uninterpretable data
No text entered.


  More Information

Certain Agreements:  
Principal Investigators are NOT employed by the organization sponsoring the study.
There IS an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
The agreement is:
unchecked The only disclosure restriction on the PI is that the sponsor can review results communications prior to public release and can embargo communications regarding trial results for a period that is less than or equal to 60 days. The sponsor cannot require changes to the communication and cannot extend the embargo.
unchecked The only disclosure restriction on the PI is that the sponsor can review results communications prior to public release and can embargo communications regarding trial results for a period that is more than 60 days but less than or equal to 180 days. The sponsor cannot require changes to the communication and cannot extend the embargo.


Results Point of Contact:  
Name/Title: Trial Transparency Team
Organization: sanofi
e-mail: Contact_US@sanofi.com


Publications of Results:

Other Publications:

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):


Responsible Party: Sanofi
ClinicalTrials.gov Identifier: NCT00069784     History of Changes
Other Study ID Numbers: LTS6035
HOE901/4032 ( Other Identifier: previous Aventis study number )
First Submitted: October 1, 2003
First Posted: October 6, 2003
Results First Submitted: December 18, 2012
Results First Posted: January 25, 2013
Last Update Posted: January 31, 2013