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Trial · Interventional

CompletedPhase 3Registry data

A Research Study to See How Well New Weekly Medicine IcoSema, Which is a Combination of Insulin Icodec and Semaglutide, Controls Blood Sugar Levels in People With Type 2 Diabetes (T2D), Compared to Daily Insulin Glargine (COMBINE 4)

Short name COMBINE 4

NCTNCT06269107 (opens ClinicalTrials.gov in a new tab)Other idNN1535-4988Other idU1111-1283-8648Other id2022-502484-38-00

This trial does not test a peptide that PepBank tracks.

  • Names Semaglutide, does not test it. It appears in the title.

Overview

Status
Completed
Phase
Phase 3
Enrollment
485 participants (actual)
Sponsor
Novo Nordisk A/S · Industry
Design
Randomized · Open label (no masking)
Countries
10 countries

United States, China, Greece, India, Italy, Japan, Poland, Puerto Rico, South Africa, Turkey (Türkiye)

Start
15 Feb 2024
Primary completion
27 May 2025
Completion
8 Jul 2025
First posted
21 Feb 2024
Last update posted
5 Jun 2026
Conditions
Type 2 Diabetes

Timeline

1 trial · 1 completed

  • Completed
  • Ongoing
  • Not yet recruiting
  • Stopped
  • Estimated dates (est.)
  • Results posted
202420252026
  1. Ph 3

    COMBINE 4

    NCT06269107

    15 Feb 2024 to 8 Jul 2025

Registry summary

Text and fields below are the sponsor's entries at ClinicalTrials.gov, shown as posted.

This study will compare the new medicine IcoSema, which is a combination of insulin icodec and semaglutide, taken once a week, to insulin glargine (mentioned as insulin glargine in this form) taken daily in people with type 2 diabetes. The study will look at how well IcoSema controls blood sugar levels as compared to insulin glargine in people with type 2 diabetes who do not have their blood sugar properly controlled with other oral diabetes medicines. Participant will either get IcoSema or insulin glargine. Which treatment participants get is decided by chance. IcoSema is a new medicine that doctors cannot prescribe. Doctors can already prescribe insulin glargine in many countries. The study will last for about 11 months (47 weeks).

Interventions

  • IcoSemaDrug
  • Insulin glargineDrug

Arms2

  • Experimental

    IcoSema

    Participants will receive once weekly IcoSema subcutaneously with or without oral anti diabetic drugs for 40 weeks.

  • Experimental

    Insulin glargine

    Participants will receive once daily insulin glargine subcutaneously with or without oral anti diabetic drugs for 40 weeks.

Primary outcomes1

Outcomes the sponsor listed as primary.

  1. Change in glycated haemoglobin (HbA1c)

    Time frame · From baseline (week 0) to week 40

    Registry description

    Measured in percentage (%)-point.

Secondary outcomes(10)
  1. Change in body weight

    Time frame · From baseline (week 0) to week 40

    Registry description

    Measured in kilogram (kg).

  2. Time in range 3.9-10.0 millimoles per liter (mmol/L) (70-180 milligram per deciliter [mg/dL])

    Time frame · From week 36 to week 40

    Registry description

    Measured in % of readings.

  3. Time spent less than (<) 3.0 mmol/L (54 mg/dL)

    Time frame · From week 36 to week 40

    Registry description

    Measured in % of readings.

  4. Time spent greater than (>) 10.0 mmol/L (180 mg/dL)

    Time frame · From week 36 to week 40

    Registry description

    Measured in % of readings.

  5. Weekly basal insulin dose

    Time frame · From week 38 to week 40

    Registry description

    Measured in units of insulin.

  6. Change in fasting plasma glucose (FPG)

    Time frame · From baseline (week 0) to week 40

    Registry description

    Measured in mmol/l.

  7. Change in Diabetes Treatment Satisfaction Questionnaire (DTSQs) in total treatment satisfaction

    Time frame · From baseline (week 0) to week 40

    Registry description

    The DTSQs items are scored on a 7-point graded response scale ranging from 0 to 6. Score ranges from 0 to 36. Higher scores indicate greater the satisfaction with medication.

  8. Number of clinically significant hypoglycaemic episodes (level 2) (<3.0 mmol/L (54 mg/dL), confirmed by blood glucose meter) or severe hypoglycaemic episodes (level 3)

    Time frame · From baseline (week 0) to week 45

    Registry description

    Measured in number of episodes.

  9. Number of clinically significant hypoglycaemic episodes (level 2) (<3.0 mmol/L (54 mg/dL), confirmed by BG meter)

    Time frame · From baseline (week 0) to week 45

    Registry description

    Measured in number of episodes.

  10. Number of severe hypoglycaemic episodes (level 3)

    Time frame · From baseline (week 0) to week 45

    Registry description

    Measured in number of episodes.

Posted results

Values are shown as posted at ClinicalTrials.gov, with their units. PepBank has not converted, pooled or compared them.

No results are posted for this trial.

Completed trials do not always post results.

Registry data comes from ClinicalTrials.gov. Study results come from studies, not from the registry. How PepBank works

Studies1

Studies that cite this trial.

Studies with results

1 study on this page

Indexing hint: Randomized controlled trial · 2026

4 results

Once-weekly IcoSema versus once-daily insulin glargine U100 in type 2 diabetes management (COMBINE 4): an open-label, multicentre, treat-to-target, randomised, phase 3b trial.

Ji et al. 2026The lancet. Diabetes & endocrinologycited by 1

PMID 42594928DOI 10.1016/s2213-8587(26)00136-1PUB-42594928

Full text at the publisher4 results

Eligibility

Who could join, as posted.

Sex
All
Age
from 18 Years
Healthy volunteers
Not accepted
Inclusion and exclusion criteria, as posted
Inclusion Criteria: * Male or female and age above or equal to 18 years at the time of signing the informed consent. * Diagnosed with T2D greater than or equal to (≥) 180 days before screening. * HbA1c ≥ 8.0% (≥ 64.0 millimoles per mole \[mmol/mol\]) as assessed by central laboratory on the day of screening. * Insulin naïve. Short term insulin treatment for a maximum of 14 consecutive days before screening is allowed, as is prior insulin treatment for gestational diabetes. * Currently treated with 1-3 oral anti diabetic drug (OADs) with stable daily doses ≥ 90 days before screening comprising any of the following anti diabetic drug(s) at effective or maximum tolerated dose. * Metformin * Sulfonylureas * Meglitinides (glinides) * Dipeptidyl peptidase (DPP) 4 inhibitors * Sodium glucose co transporter 2 inhibitors * Alpha glucosidase inhibitors * Thiazolidinediones * Marketed oral combination products only including the products listed above. * Body mass index (BMI) less than or equal to (≤) 40.0 kilogram per square meter (kg/m\^2). Exclusion Criteria: * Female who is pregnant, breast-feeding or intends to become pregnant or is of childbaring potential and not using highly effective contraceptive method. * Anticipated initiation or change in concomitant medication (for more than 14 consecutive days) known to affect weight or glucose metabolism (e.g. treatment with orlistat, thyroid hormones, or systemic corticosteroids). * Any episodes of diabetic ketoacidosis or treatment with any medication for the indication of diabetes or obesity other than stated in the inclusion criteria within 90 days before screening. * Presence or history of pancreatitis (acute or chronic) within 180 days before screening. * Any of the following: Myocardial infarction, stroke, hospitalization for unstable angina pectoris or transient ischaemic attack within 180 days before screening. * Chronic heart failure classified as being in New York Heart Association Class IV at screening. * Recurrent severe hypoglycaemic episodes within the last year (12 months) as judged by the investigator. * Uncontrolled and potentially unstable diabetic retinopathy or maculopathy. Verified by a fundus examination performed within the past 90 days before screening or in the period between screening and randomisation. Pharmacological pupil dilation is a requirement unless using a digital fundus photography camera specified for non dilated examination.

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