g per day) in monotherapy. Patients were randomized to the addition of either linagliptin 5 mg or placebo, administered once daily. Patients who failed to meet specific glycemic goals during the studies were treated with glimepiride rescue.
In combination with metformin, linagliptin provided statistically significant improvements in A1C, FPG, and 2-hour PPG compared with placebo (Table 5). Rescue glycemic therapy was used in 7.8% of patients treated with linagliptin 5 mg and in 18.9% of patients treated with placebo. The mean change from baseline in A1C of TRADJENTA/metformin versus placebo/metformin over the 24-week treatment period is shown in Figure 2. A similar decrease in body weight was observed for both treatment groups.
Table 5 Glycemic Parameters in Placebo-Controlled Study for TRADJENTA in Combination with Metformin* TRADJENTA 5 mg + Metformin Placebo + Metformin
*Full analysis population using last observation on study
A1C (%)
Number of patients n = 513 n = 175
Baseline (mean) 8.1 8.0
Change from baseline (adjusted mean) -0.5 0.15
Difference from placebo + metformin (adjusted mean) (95% CI) -0.6 (-0.8, -0.5)
Patients (%) achieving A1C <7% 145 (28.3) 20 (11.4)
FPG (mg/dL)
Number of patients n = 495 n = 159
Baseline (mean) 169.0 163.8
Change from baseline (adjusted mean) -10.7 10.5
Difference from placebo + metformin (adjusted mean) (95% CI) -21.1 (-27.3, -15.0)
2-hour PPG (mg/dL)
Number of patients n = 78 n = 21
Baseline (mean) 270 274
Change from baseline (adjusted mean) -48.9 18.3
Difference from placebo + metformin (adjusted mean) (95% CI) -67.1 (-94.7, -39.6)
Active-Controlled Study vs Glimepiride in Combination with Metformin
The efficacy of linagliptin is being eva luated in a 104-week double-blind, glimepiride-controlled non-inferiority study in type 2 diabetic patients with insufficient glycemic control despite metformin therapy. Patients being treated with metformin only entered a run-in period of 2 weeks duration, whereas patients pretreated with metformin and one additional antihyperglycemic agent entered a run-in treatment period of 6 weeks duration with metformin monotherapy (dose of ≥1500 mg per day) and washout of the other agent. After an additional 2-week placebo run-in period, those with inadequate glycemic control (A1C 6.5% to 10%) were randomized 1:1 to the addition of linagliptin 5 mg once daily or glimepiride. Patients receiving glimepiride were given an initial dose of 1 mg/day and then electively titrated over the next 12 weeks to a maximum dose of 4 mg/day as needed to optimize glycemic control. Thereafter, the glimepiride dose was to be kept constant, except for down-titration to prevent hypoglycemia.
After 52 weeks, linagliptin and glimepiride both had reductions from baseline in A1C (-0.4% for linagliptin, -0.6% for glimepiride) from a baseline mean of 7.7% (Table 6). The mean difference between groups in HbA1c change from baseline was 0.2% with 2-sided 97.5% confidence interval (0.1%, 0.3%) for the intent-to-treat population using last observation carried forward. These results were consistent with the completers analysis.
Patients treated with linagliptin exhibited a significant mean decrease from baseline body |
