Abstract
The prevalence of type 2 diabetes mellitus (T2DM) is rapidly increasing in India. Additional antihyperglycemic treatment options are important for patients who cannot achieve glycemic control through diet and exercise. The dipeptidyl peptidase 4 (DPP-4) inhibitor saxagliptin is efficacious and well tolerated in Western patients with T2DM but has not been tested prospectively in a dedicated study in Indian patients. A multicenter, randomized, double-blind, placebo-controlled, parallel-group study was conducted in India to evaluate the efficacy and safety of saxagliptin. Treatment-naive adults with T2DM and glycated hemoglobin (HbA1c) between 7.0 % and 10.0 % at randomization were recruited. Patients were assigned 1:1 to receive saxagliptin 5 mg or matching placebo tablets once daily for 24 weeks. The primary efficacy endpoint was change from baseline to week 24 in HbA1c, using last observation carried forward methodology. Two hundred thirteen patients were randomized (saxagliptin, N = 107; placebo, N = 106). Adjusted mean absolute reductions in HbA1c from baseline to week 24 were significantly greater with saxagliptin (−0.51 % ;N = 104) versus placebo (−0.05 %; n = 105; difference for saxagliptin vs placebo, −0.46 %; SE, 0.14 %; 95 % CI, −0.73 %, −0.18 %; P = 0.0011). The incidence of adverse events was 47.7 % with saxagliptin and 45.3 % with placebo. No deaths, serious adverse events, or reported or confirmed hypoglycemic events occurred. Saxagliptin provided statistically and clinically significant improvement in HbA1c for Indian patients, similar to previous findings in Western study populations. Saxagliptin was well tolerated, with no previously unidentified safety findings, and had a safety profile comparable to placebo.
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Acknowledgments
This study was funded by Bristol-Myers Squibb and AstraZeneca and designed and supervised by scientists at Bristol-Myers Squibb and AstraZeneca. The authors thank the study participants and site staff who assisted with this research. Bristol-Myers Squibb and AstraZeneca personnel collated and analyzed the data and reviewed the manuscript before submission for publication. Medical writing services were provided by Michael J. Theisen, PhD, Erica S. Wehner, RPh, and Judy Fallon, PharmD, Complete Healthcare Communications, Inc., with funding from Bristol-Myers Squibb and AstraZeneca.
The authors thank the principal investigators for their contributions to this study.
Principal study investigators
Dr. Abhay Mutha, Maharashtra; Dr. Sanjay Kalra; Haryana; Dr. P. Usha Rani, Andhra Pradesh; Dr. Harish Kumar, Kerala; Dr. V. Balaji, Tamil Nadu; Dr. Sathyanarayana Srikanta, Karnataka; Dr. Arpandev Bhattacharyya, Karnataka; Dr. Girithara Gopalkrishnan, Tamil Nadu; Dr. Navneet Shah, Gujarat; Dr. C.S. Yajnik, Maharashtra; and Dr. Sanjay Reddy, Karnataka.
Conflict of interest
Dr. Prasanna Kumar and Dr. Jain participated in clinical research of saxagliptin in India and received principal investigator fees for this research. Dr. Tou and Dr. Schützer are employees of AstraZeneca and hold shares of AstraZeneca stock.
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The study was designed and supervised by scientists at Bristol-Myers Squibb and AstraZeneca. Bristol-Myers Squibb and AstraZeneca personnel also collated and analyzed the data and reviewed the manuscript before submission for publication. All authors contributed to the analysis and interpretation of study data; participated in manuscript preparation, editing, and review; and critically reviewed and approved the manuscript before submission. K.-J. Schützer is the guarantor for this manuscript. K.M. Prasanna Kumar and S.M. Jain recruited and treated patients; K.M. Prasanna Kumar was also the national study coordinator.
Registered as entry NCT00918879 at http://www.clinicaltrials.gov.
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Kumar, K.M.P., Jain, S.M., Tou, C. et al. Saxagliptin as initial therapy in treatment-naive Indian adults with type 2 diabetes mellitus inadequately controlled with diet and exercise alone: a randomized, double-blind, placebo-controlled, phase IIIb clinical study. Int J Diabetes Dev Ctries 34, 201–209 (2014). https://doi.org/10.1007/s13410-014-0191-1
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DOI: https://doi.org/10.1007/s13410-014-0191-1