Change in HbA1c From Baseline to Week 24: Non-Inferiority Analysis
| Group | Value (percentage of HbA1c) | Spread |
|---|---|---|
| iGlarLixi | -1.88 | 0.05 |
| IDegAsp | -1.68 | 0.05 |
Trial · Interventional
CompletedPhase 3Results postedRegistry dataChina
1 trial · 1 completed · 1 with posted results
Text and fields below are the sponsor's entries at ClinicalTrials.gov, shown as posted.
This was a parallel-group treatment, Phase 3, randomized, 2-arm study that assessed the efficacy and safety of iGlarLixi to IDegAsp in Chinese T2DM participants insufficiently controlled with oral antidiabetic drug(s). Study details included: * Study duration per participant: approximately up to 27 weeks * Treatment duration: 24 weeks * Visit frequency: after screening (an on-site visit), on-site or phone call visit every 1 week from randomization till Week 4, every 2 weeks till week 12 and then every 3 weeks till Week 24 (End of Treatment). There were 14 visits that included 7 phone calls and 7 on-site visits in total during screening and treatment periods. There was a safety follow-up by a phone call visit (End of Study) in 3 days after the last dose of the treatment. * Health measurement/Observation: change in HbA1c as the primary endpoint. * Intervention name: iGlarLixi and IDegAsp * Participant sex: male and female * Participant age range: adults at least 18 years of age * Condition/disease: Type 2 diabetes mellitus
Experimental
iGlarLixi
Participants self-administered iGlarLixi (100 units per milliliter \[U/mL\] insulin glargine + 100 or 50 microgram \[mcg\]/mL lixisenatide respectively) subcutaneous (SC) injection once daily on top of metformin +/- sodium-glucose co-transporter 2 inhibitor (SGLT-2i) for 24 weeks. Dose was individually adjusted.
Active comparator
IDegAsp
Participants self-administered IDegAsp (100 U/mL of insulin degludec + insulin aspart with a ratio of 70:30) SC injection once daily on top of metformin +/- SGLT-2i for 24 weeks. Dose was individually adjusted.
Outcomes the sponsor listed as primary.
Change in HbA1c From Baseline to Week 24: Non-Inferiority Analysis
Time frame · Baseline, Week 24
Blood samples were collected at indicated timepoints for analysis of HbA1c. Baseline was defined as the last available pre-dose assessment (on or before Day 1).
Change in HbA1c From Baseline to Week 24: Superiority Analysis
Time frame · Baseline, Week 24
Blood samples were collected at indicated timepoints for analysis of HbA1c. Baseline was defined as the last available pre-dose assessment (on or before Day 1).
Change in Body Weight From Baseline to Week 24
Time frame · Baseline, Week 24
Body weight was obtained with the participant wearing undergarments or very light clothing and no shoes, and with an empty bladder. The same scale was used throughout the study. Baseline was defined as the last available pre-dose assessment (on or before Day 1).
Percentage of Participants Reaching HbA1c <7% at Week 24
Time frame · Week 24
Blood samples were collected at indicated timepoints for analysis of HbA1c. Participants without Week 24 HbA1c value were considered as non-responders. Percentages are rounded off to the tenth decimal place.
Percentage of Participants Reaching HbA1c <7% With no Body Weight Gain at Week 24
Time frame · Week 24
Blood samples were collected at indicated timepoints for analysis of HbA1c. Participants without Week 24 HbA1c or body weight value were considered as non-responders. Percentages are rounded off to the tenth decimal place.
Percentage of Participants Reaching HbA1c <7% With no Body Weight Gain at Week 24 and no Hypoglycemia During 24-Week Treatment Period
Time frame · Baseline up to Week 24
Blood samples were collected at indicated timepoints for analysis of HbA1c. Participants without Week 24 HbA1c or body weight value were considered as non-responders. During the study, participants were instructed to document the presence of hypoglycemic episodes in their study diary. Hypoglycemia was characterized as per American Diabetes Association (ADA) 2021 recommendations. * ADA Level 1 hypoglycemia: A measurable glucose concentration \<70 milligram/deciliter (mg/dL) (3.9 millimoles/liter \[mmol/L\]) but \>=54 mg/dL (3.0 mmol/L). * ADA Level 2 hypoglycemia: Blood glucose concentration \<54 mg/dL \[3.0 mmol/L\]; the threshold at which neuroglycopenic symptoms begin to occur and requires immediate action to resolve the hypoglycemic event. * ADA Level 3 hypoglycemia: A severe event characterized by altered mental and/or physical functioning that requires assistance from another person for recovery. Percentages are rounded off to the tenth decimal place.
Change in Fasting Plasma Glucose From Baseline to Week 24
Time frame · Baseline, Week 24
Blood samples were collected at fasting state (no food or drinks \[except water\] for at least 8 hours) at indicated timepoints. Baseline was defined as the last available pre-dose assessment (on or before Day 1).
Change in Average 7-Point Self-Monitored Plasma Glucose (SMPG) Profile From Baseline to Week 24
Time frame · Baseline, Week 24
Participants were provided with a glucometer, corresponding supplies, a leaflet, and with diaries in order to perform self-measurement of plasma glucose and its recording and were trained on how to use the glucometer. The 7-point SMPG profile was measured at the following 7-points: pre-prandial (before starting a meal) and 2 hours postprandial each for breakfast, lunch, dinner and at bedtime. Two hours postprandial (breakfast, lunch and dinner) was defined as 2 hours after the start of the meal. The participants performed 7-point SMPG profile measurement over a single 24-hour period on 2 different days in the week. Baseline was defined as the last available pre-dose assessment (on or before Day 1).
Percentage of Participants Reaching HbA1c <7% at Week 24 With no Hypoglycemia During 24-Week Treatment Period
Time frame · Baseline up to Week 24
Blood samples were collected at indicated timepoints for analysis of HbA1c. Participants without Week 24 HbA1c value were considered as non-responders. Hypoglycemia was characterized as per ADA 2021 recommendations. * ADA Level 1 hypoglycemia: A measurable glucose concentration \<70 mg/dL (3.9 mmol/L) but \>=54 mg/dL (3.0 mmol/L). * ADA Level 2 hypoglycemia: Blood glucose concentration \<54mg/dL \[3.0 mmol/L\]; the threshold at which neuroglycopenic symptoms begin to occur and requires immediate action to resolve the hypoglycemic event. * ADA Level 3 hypoglycemia: A severe event characterized by altered mental and/or physical functioning that requires assistance from another person for recovery. Percentages are rounded off to the tenth decimal place.
Percentage of Participants Reaching HbA1c <7% at Week 24 With no Clinically Relevant Hypoglycemia During 24-Week Treatment Period
Time frame · Baseline up to Week 24
Blood samples were collected at indicated timepoints for analysis of HbA1c. Participants without Week 24 HbA1c value were considered as non-responders. Participants who reached the specified target of HbA1c without any clinically significant symptoms of hypoglycemia as defined in ADA Levels 2 or 3 are reported. Percentages are rounded off to the tenth decimal place.
Total Daily Insulin Dose at Week 24
Time frame · Week 24
Total daily insulin dose was defined as the sum of the insulin dose from study treatment and non-study treatment (e.g., rescue therapy). It was the average of the last 3 available insulin doses recorded in the electronic case report form in the week before visit.
Percentage of Participants Who Required Rescue Therapy During the 24-Week Treatment Period
Time frame · Baseline up to Week 24
Routine HbA1c value was used to determine the requirement of rescue medication. Threshold value was HbA1c \>8% at Week 12 or later on despite appropriate corrective actions. Percentages are rounded off to the tenth decimal place.
Change in Fasting C-Peptide From Baseline to Week 24
Time frame · Baseline, Week 24
Blood samples were collected at fasting state (no food or drinks \[except water\] for at least 8 hours) at indicated timepoints. Baseline was defined as the last available pre-dose assessment (on or before Day 1).
Number of Participants With Any Hypoglycemia Event During On-Treatment Period
Time frame · From first dose of study drug up to 1 day after the last administration of study drug (maximum treatment exposure: 192 days)
During the study, participants were instructed to document the presence of hypoglycemic episodes in their study diary. Number of participants who met ADA definition of hypoglycemia during the treatment period are reported. * ADA Level 1 hypoglycemia: A measurable glucose concentration \<70 mg/dL (3.9 mmol/L) but \>=54 mg/dL (3.0 mmol/L). * ADA Level 2 hypoglycemia: Blood glucose concentration \<54mg/dL \[3.0 mmol/L\]; the threshold at which neuroglycopenic symptoms begin to occur and requires immediate action to resolve the hypoglycemic event. * ADA Level 3 hypoglycemia: A severe event characterized by altered mental and/or physical functioning that requires assistance from another person for recovery. The on-treatment period (ie, treatment-emergent \[TE\] period) was defined as the period from the first injection study treatment to the last injection of study treatment + 3 days (1 day for hypoglycemia).
Hypoglycemic Event Rate During the On-Treatment Period
Time frame · From first dose of study drug up to 1 day after the last administration of study drug (maximum treatment exposure: 192 days)
During the study, participants were instructed to document the presence of hypoglycemic episodes in their study diary. Percentage of hypoglycemic events per participant-year during on-treatment period are reported. The on-treatment period (TE period) was defined as the period from the first injection study treatment to the last injection of study treatment + 3 days (1 day for hypoglycemia).
Number of Participants With Treatment-Emergent Adverse Events (TEAEs), Treatment-Emergent Serious Adverse Events (TESAEs), Adverse Events Of Special Interest (AESIs) and TEAEs Leading to Treatment Discontinuation
Time frame · From signature of the informed consent form up to the final visit regardless of seriousness or relationship to study drug (maximum treatment exposure: 192 days)
An AE was any untoward medical occurrence in a participant or clinical study participant, temporally associated with the use of study intervention, whether or not considered related to the study intervention. An SAE was defined as any adverse event that, at any dose resulted in death, was life-threatening, required inpatient hospitalization or prolongation of existing hospitalization, resulted in persistent or significant disability/incapacity, was a congenital anomaly/birth defect or was a suspected transmission of any infectious agent via an authorized medicinal product. An AESI was an AE (serious or nonserious) of scientific and medical concern specific to the Sponsor's product or program, for which ongoing monitoring and immediate notification by the Investigator to the Sponsor was required. TE period was defined as the period from the first injection study treatment to the last injection of study treatment + 3 days.
Number of Participants With Potentially Clinically Significant Laboratory Abnormalities (PCSA): Vital Signs
Time frame · From first dose of study drug up to 3 days after last administration of study drug (maximum treatment exposure: 192 days)
Vital signs assessments included systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) in sitting position with their arm outstretched in line with mid-sternum and supported and weight. Criteria for PCSA: SBP: \<=95 millimeters of mercury (mmHg) and decrease from baseline \>=20 mmHg, \>=160 mmHg and increase from baseline \>=20 mmHg; DBP :\<=45 mmHg and decrease from baseline \>=10 mmHg,\>=110 mmHg and increase from baseline \>=10 mmHg; HR: \<=50 beats/min and decrease from baseline \>=20 beats/min,\>=120 beats/min and increase from baseline \>=20 beats/min; Weight \>=5% decrease from baseline, \>=5% increase from baseline.
Number of Participants With Potentially Clinically Significant Laboratory Abnormalities (PCSA): Hematology
Time frame · From first dose of study drug up to 3 days after last administration of study drug (maximum treatment exposure: 192 days)
Criteria for PCSA: For Hemoglobin (Hb), there are 3 criteria: (1)\<=115 grams (g)/L (Male\[M\]) or \<=95 g/L (Female\[F\]), (2)\>= 185 g/L (M) or \>=165 g/L (F), and (3) decrease from baseline \>=20 g/L; Hematocrit: \<=0.37 volume/volume (v/v) (M) or \<=0.32 v/v (F), \>=0.55 v/v (M) or \>=0.5 v/v (F); Red blood cells (RBC): \>=6 Tera/L; Platelets: \<100 Giga/L, \>=700 Giga/L; White blood cells (WBC): \<3.0 Giga/L (Non-Black \[NB\]); \<2.0 Giga/L (Black \[B\]) or \>=16.0 Giga/L; Neutrophils: \<1.5 Giga/L (NB) or \<1.0 Giga/L (B); Lymphocytes: \>4.0 Giga/L; Monocytes: \>0.7 Giga/L; Basophils: \>0.1 Giga/L; Eosinophils: \>0.5 Giga/L or \>upper limit of normal (ULN) (if ULN \>=0.5 Giga/L).
Number of Participants With Potentially Clinically Significant Laboratory Abnormalities (PCSA): Clinical Chemistry
Time frame · From first dose of study drug up to 3 days after last administration of study drug (maximum treatment exposure: 192 days)
Criteria for PCSA: Lipase: \>=3 ULN; Amylase: \>=3 ULN; Sodium: \<=129 mmol/L; \>=160 mmol/L; Potassium: \<3 mmol/L, \>=5.5 mmol/L; Creatinine: \>=150 micromoles per liter (umol/L), \>=30% or \>=100% change from baseline; Glomerular filtration rate (GFR): \>=60-\<90 mL/minute(min)/1.73 square meter (m\^2) (mild decrease in GFR), \>=30-\<60 mL/min/1.73m\^2 (moderate decrease in GFR), \>=15-\<30 mL/min/1.73m\^2 (severe decrease in GFR),\<15 mL/min/1.73m\^2 (end stage renal disease); Creatinine clearance (CG): \>=60-\<90 mL/min (mild decrease in GFR), \>=30-\<60 mL/min (moderate decrease in GFR), \>=15-\<30 mL/min (severe decrease in GFR), \<15 mL/min (end stage renal disease); Urea nitrogen (BUN): \>=17 mmol/L and Uric acid: \<120 or \>408 umol/L; Alanine transaminase (ALT) and aspartate transaminase (AST): \>3/5/10/20 ULN. Alkaline phosphatase:\>1.5 ULN, total bilirubin (TBILI): \>1.5 or \>2 ULN, ALT and TBILI:\> ALT\>3ULN and TBILI \>2 ULN and Conjugated and total bilirubin: \>35% TBILI and TBILI \>1.5 ULN.
Values are shown as posted at ClinicalTrials.gov, with their units. PepBank has not converted, pooled or compared them.
| Group | Value (percentage of HbA1c) | Spread |
|---|---|---|
| iGlarLixi | -1.88 | 0.05 |
| IDegAsp | -1.68 | 0.05 |
| Group | Value (percentage of HbA1c) | Spread |
|---|---|---|
| iGlarLixi | -1.88 | 0.05 |
| IDegAsp | -1.68 | 0.05 |
| Group | Value (kilogram) | Spread |
|---|---|---|
| iGlarLixi | -0.30 | 0.29 |
| IDegAsp | 1.19 | 0.25 |
| Group | Value (percentage of participants) |
|---|---|
| iGlarLixi | 72.5 |
| IDegAsp | 59.8 |
| Group | Value (percentage of participants) |
|---|---|
| iGlarLixi | 40.5 |
| IDegAsp | 21.3 |
| Group | Value (percentage of participants) |
|---|---|
| iGlarLixi | 26.5 |
| IDegAsp | 13.4 |
| Group | Value (mmol/L) | Spread |
|---|---|---|
| iGlarLixi | -3.18 | 0.11 |
| IDegAsp | -3.45 | 0.11 |
| Group | Value (mmol/L) | Spread |
|---|---|---|
| iGlarLixi | -3.36 | 0.12 |
| IDegAsp | -2.92 | 0.11 |
| Group | Deaths | Serious events | Other events |
|---|---|---|---|
| iGlarLixiParticipants self-administered iGlarLixi (100 U/mL insulin glargine + 100 or 50 mcg/mL lixisenatide respectively) SC injection once daily on top of metformin +/- SGLT-2i for 24 weeks. Dose was individually adjusted. | 0 / 290 | 15 / 290 | 152 / 290 |
| IDegAspParticipants self-administered IDegAsp (100 U/mL of insulin degludec + insulin aspart with a ratio of 70:30) SC injection once daily on top of metformin +/- SGLT-2i for 24 weeks. Dose was individually adjusted. | 0 / 291 | 12 / 291 | 101 / 291 |
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