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    Summary
    EudraCT Number:2006-005383-51
    Sponsor's Protocol Code Number:H7U-MC-IDAZ
    National Competent Authority:Spain - AEMPS
    Clinical Trial Type:EEA CTA
    Trial Status:Completed
    Date on which this record was first entered in the EudraCT database:2012-03-30
    Trial results View results
    Index
    A. PROTOCOL INFORMATION
    B. SPONSOR INFORMATION
    C. APPLICANT IDENTIFICATION
    D. IMP IDENTIFICATION
    D.8 INFORMATION ON PLACEBO
    E. GENERAL INFORMATION ON THE TRIAL
    F. POPULATION OF TRIAL SUBJECTS
    G. INVESTIGATOR NETWORKS TO BE INVOLVED IN THE TRIAL
    N. REVIEW BY THE COMPETENT AUTHORITY OR ETHICS COMMITTEE IN THE COUNTRY CONCERNED
    P. END OF TRIAL
    Expand All   Collapse All
    A. Protocol Information
    A.1Member State ConcernedSpain - AEMPS
    A.2EudraCT number2006-005383-51
    A.3Full title of the trial
    A Phase 3, Open-Label, Crossover Study to Evaluate the
    Efficacy and Safety of Human Insulin Inhalation Powder
    (HIIP) Compared with Once-Daily Insulin Glargine in
    Insulin-Naïve Patients with Type 2 Diabetes Mellitus on
    Oral Agents
    Estudio de fase 3, cruzado y abierto, para evaluar la eficacia y seguridad de la Insulina Humana en Polvo para Inhalación comparada con insulina Glargina una vez al día en pacientes con Diabetes Mellitus tipo 2 con antidiabéticos orales no tratados previamente con insulina
    A.3.1Title of the trial for lay people, in easily understood, i.e. non-technical, language
    Study to Evaluate the Efficacy and Safety of Human Insulin Inhalation Powder
    (HIIP) Compared with Once-Daily Insulin Glargine in
    Insulin-Naïve Patients with Type 2 Diabetes Mellitus on
    Oral Agents
    Estudio para evaluar la eficacia y seguridad de la Insulina Humana en Polvo para Inhalación comparada con insulina Glargina una vez al día en pacientes con Diabetes Mellitus tipo 2 con antidiabéticos orales no tratados previamente con insulina
    A.4.1Sponsor's protocol code numberH7U-MC-IDAZ
    A.7Trial is part of a Paediatric Investigation Plan No
    A.8EMA Decision number of Paediatric Investigation Plan
    B. Sponsor Information
    B.Sponsor: 1
    B.1.1Name of SponsorLilly S.A.
    B.1.3.4CountrySpain
    B.3.1 and B.3.2Status of the sponsorCommercial
    B.4 Source(s) of Monetary or Material Support for the clinical trial:
    B.4.1Name of organisation providing supportLilly S.A.
    B.4.2CountrySpain
    B.5 Contact point designated by the sponsor for further information on the trial
    B.5.1Name of organisationLilly S.A.
    B.5.2Functional name of contact pointClinical Operations
    B.5.3 Address:
    B.5.3.1Street AddressAvda de la Industria 30
    B.5.3.2Town/ cityAlcobendas Madrid
    B.5.3.3Post code28108
    B.5.3.4CountrySpain
    B.5.4Telephone number34916633485
    B.5.5Fax number34916633481
    B.5.6E-mailjulian_inmaculada@lilly.com
    D. IMP Identification
    D.IMP: 1
    D.1.2 and D.1.3IMP RoleTest
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation No
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameInsulina Humana en Polvo para Inhalación
    D.3.2Product code LY041001
    D.3.4Pharmaceutical form Inhalation powder, pre-dispensed
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPInhalation use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNInsulana Humana
    D.3.9.2Current sponsor codeLY041001
    D.3.9.3Other descriptive nameN/A
    D.3.10 Strength
    D.3.10.1Concentration unit mg milligram(s)
    D.3.10.2Concentration typerange
    D.3.10.3Concentration number0.9 to 9
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.IMP: 2
    D.1.2 and D.1.3IMP RoleComparator
    D.2 Status of the IMP to be used in the clinical trial
    D.2.1IMP to be used in the trial has a marketing authorisation Yes
    D.2.1.1.1Trade name Insulina glargina
    D.2.1.1.2Name of the Marketing Authorisation holderLantus
    D.2.1.2Country which granted the Marketing AuthorisationSpain
    D.2.5The IMP has been designated in this indication as an orphan drug in the Community No
    D.2.5.1Orphan drug designation number
    D.3 Description of the IMP
    D.3.1Product nameLantus
    D.3.4Pharmaceutical form Solution for injection
    D.3.4.1Specific paediatric formulation No
    D.3.7Routes of administration for this IMPSubcutaneous use
    D.3.8 to D.3.10 IMP Identification Details (Active Substances)
    D.3.8INN - Proposed INNInsulina glargina
    D.3.9.1CAS number 160337-95-1
    D.3.9.2Current sponsor codeLantus
    D.3.9.3Other descriptive nameN/A
    D.3.10 Strength
    D.3.10.1Concentration unit IU/ml international unit(s)/millilitre
    D.3.10.2Concentration typeequal
    D.3.10.3Concentration number100
    D.3.11 The IMP contains an:
    D.3.11.1Active substance of chemical origin No
    D.3.11.2Active substance of biological/ biotechnological origin (other than Advanced Therapy IMP (ATIMP) Yes
    The IMP is a:
    D.3.11.3Advanced Therapy IMP (ATIMP) No
    D.3.11.3.1Somatic cell therapy medicinal product No
    D.3.11.3.2Gene therapy medical product No
    D.3.11.3.3Tissue Engineered Product No
    D.3.11.3.4Combination ATIMP (i.e. one involving a medical device) No
    D.3.11.3.5Committee on Advanced therapies (CAT) has issued a classification for this product No
    D.3.11.4Combination product that includes a device, but does not involve an Advanced Therapy No
    D.3.11.5Radiopharmaceutical medicinal product No
    D.3.11.6Immunological medicinal product (such as vaccine, allergen, immune serum) No
    D.3.11.7Plasma derived medicinal product No
    D.3.11.8Extractive medicinal product No
    D.3.11.9Recombinant medicinal product Yes
    D.3.11.10Medicinal product containing genetically modified organisms No
    D.3.11.11Herbal medicinal product No
    D.3.11.12Homeopathic medicinal product No
    D.3.11.13Another type of medicinal product No
    D.8 Information on Placebo
    E. General Information on the Trial
    E.1 Medical condition or disease under investigation
    E.1.1Medical condition(s) being investigated
    Type II diabetes
    DIabetes Mellitus tipo II
    E.1.1.1Medical condition in easily understood language
    Diabetes
    Diabetes
    E.1.1.2Therapeutic area Diseases [C] - Nutritional and Metabolic Diseases [C18]
    MedDRA Classification
    E.1.2 Medical condition or disease under investigation
    E.1.2Version 14.1
    E.1.2Level PT
    E.1.2Classification code 10067585
    E.1.2Term Type 2 diabetes mellitus
    E.1.2System Organ Class 10027433 - Metabolism and nutrition disorders
    E.1.3Condition being studied is a rare disease No
    E.2 Objective of the trial
    E.2.1Main objective of the trial
    The primary objective of this randomized, crossover study is to compare, in
    approximately 132 insulin-naïve patients with type 2 diabetes who have inadequate
    glycemic control on one or more oral antihyperglycemic medications (OAM), a regimen adding mealtime HIIP (?HIIP+orals?) versus a regimen adding insulin glargine (?glargine+orals?) with respect to change in HbA1c from baseline (Visit 3) to endpoint.
    Superiority with respect to HbA1c will be concluded if the upper limit of the 95%
    confidence interval for the treatment difference (?HIIP+orals? inus ?glargine+orals?) is less than zero. Noninferiority will be concluded if this upper limit is less than 0.4%, but greater than or equal to 0.0%.
    El objetivo primario de este estudio aleatorizado y cruzado es el de comparar un régimen que incorpora la IHPI en las comidas (?IHPI+orales?) con uno que incorpora insulina glargina (?glargina+orales?) en términos del cambio de HbA1c desde la situación inicial (Visita 3) hasta el fin del estudio en aproximadamente 132 pacientes con diabetes tipo 2 sin tratamiento previo con insulina y que tienen un control glucémico insuficiente con su régimen de uno o más antihiperglucemiantes orales (AO). La superioridad con respecto a la HbA1c quedará confirmada si el límite superior del intervalo de confianza del 95% para la diferencia de ambos tratamientos (?IHPI + orales? menos ?glargina + orales?) es inferior a cero. Se determinará no inferioridad si este límite superior es inferior al 0,4%, pero superior o igual al 0,0%.
    E.2.2Secondary objectives of the trial
    1) To compare the ?HIIP+orals? treatment versus ?glargine+orals? treatment, with
    respect to the following:
    ? Mean change in HbA1c from baseline,
    ? % of patients who achieve or maintain HbA1c <7% and, in a separate analysis, ?6.5%,
    ? 8-point self-monitored blood glucose profiles obtained at baseline and at the end of each study period,
    ? Total insulin dose requirements,
    ? Patient-reported preference, evaluation of insulin delivery system satisfaction, lifestyle impact of insulin delivery system, diabetes treatment satisfaction, energy, fatigue, cognitive distress symptoms, hyperglycemia symptoms, ease of dosing, positive well-being, negative well-being, and hypoglycemia symptoms,
    ? Hypoglycemia
    ? Changes in body weight,
    ? Adverse events,
    ? Safety as assessed by total pulmonary function testing; diffusing capacity of the lung for carbon monoxide; and Pulmonary Symptoms Questionnaire,
    ? Standard fasting lipid profile.
    2) To assess inhaler reliability.
    1) Comparar ?IHPI+orales? con ?glargina+orales?, en cuanto a:
    ?El cambio medio en la HbA1c
    ?La proporción de pacientes que alcanzan o mantienen un nivel de HbA1c <7% y, en un análisis separado, ?6,5%,
    ?Los perfiles de autodeterminación de la glucemia de 8 puntos obtenidos en el momento inicial y al final de cada período del estudio
    ?Dosis necesaria de insulina,
    ?Las preferencias de los pacientes, cuestionario de satisfacción con el sistema de administración, impacto en el estilo de vida , satisfacción con el tratamiento , nivel de energía, cansancio, fatiga cognitiva, síntomas de hiperglucemia, comodidad de dosificación, bienestar positivo, bienestar negativo y síntomas de hipoglucemia,
    ?Hipoglucemia
    ?Cambios en el peso corporal
    ?Acontecimientos adversos
    ?Seguridad evaluada por las pruebas de función pulmonar totales y el cuestionario de síntomas pulmonares ,
    ?perfil lipídico estándar en ayunas
    2) Valorar la fiabilidad del inhalador.
    E.2.3Trial contains a sub-study No
    E.3Principal inclusion criteria
    [1] male or female patients who are 18 years of age or older,
    [2] patients who have had type 2 diabetes mellitus for at least 6 months?
    duration at study entry,
    [3] patients who have been treated with one or more OAMs on a stable
    dose for at least 6 weeks (12 weeks for thiazolidinediones [TZDs]),
    AND
    ? have been on insulin for 30 days or less throughout life and have not
    taken insulin within 6 months,
    AND
    ? are candidates for insulin therapy, in the opinion of the investigator.
    [4] patients who have HbA1c ?8.0 and ?10.5% at screening,
    ? If the HbA1c criterion is not met at the first screening visit, the
    patient may undergo retest of HbA1c once within a 3-month
    period. If less than 1 month has passed since the initial screening,
    only the HbA1c test will be repeated. If more than 1 month, but
    less than 3 months have passed, the entire screening panel will be
    repeated except cotinine.
    ? Retesting may occur as long as the screening period for the study is
    still ongoing at the time of the retest.
    [5] if female, patients must not be breastfeeding,
    and
    if female patients are of childbearing potential (not surgically sterilized
    and between menarche and 1 year postmenopausal), they must
    ? test negative for pregnancy at the time of screening based on a
    urine or serum test,
    ? intend not to become pregnant during the study,
    and
    ? agree to use a reliable method of birth control (for example, use of
    oral contraceptives or Norplant®; a reliable barrier method of birth
    control [diaphragms with contraceptive jelly; cervical caps with
    contraceptive jelly; condoms with contraceptive foam; intrauterine
    devices]; partner with vasectomy) during the study.
    [6] patients who are nonsmokers, have not smoked for at least 6 months
    prior to entering the study, and agree not to smoke (cigars, cigarettes,
    or pipes) or use smokeless tobacco for the duration of the study.
    Serum cotinine level must be <20 ng/mL at screening,
    ? If the patient is a nonsmoker for a period of ?6 months, and the
    serum cotinine level is ?20 and ?100 ng/mL, the patient may
    undergo retesting of serum cotinine once within a 4-week period.
    ? Retesting may occur as long as the screening period for the study is
    still ongoing at the time of the retest.
    [7] patients who are able to perform pulmonary function testing, according
    to guidelines from the American Thoracic Society (ATS) (ATS 1995),
    [8] patients who have PFTs graded as ?A,? ?B,? or ?C? in quality and
    satisfy all of the following criteria for PFTs:
    ? DLCO >70% of predicted,
    ? FEV1/FVC > lower limit of normal and FEV1 >70% predicted,
    ? patients should be able to perform at least 3 acceptable FEV1
    and FVC maneuvers, and 2 acceptable DLCO maneuvers. For
    each test, 2 of the maneuvers must be reproducible (within
    0.20 L for FEV1 and FVC; and within 2.5 standard DLCO units
    for DLCO).
    ? If the patients are not able to meet the reproducibility
    criteria for FEV1, FVC, or DLCO maneuvers, they may
    return for retest within a 4-week period.
    ? If the grade for FEV1, FVC, or DLCO is ?D? or ?F,?
    patients may return for retest within a 4-week period.
    ? Retesting may occur as long as the screening period is still
    ongoing at the time of the retest.
    [9] patients who have a chest x-ray (posteroanterior and lateral views)
    without evidence of clinically significant pulmonary abnormalities
    (including severe bullous disease), in the opinion of the investigator.
    (Scarring due to inactive tuberculosis is not exclusionary. If an x-ray
    (posteroanterior and lateral views) has been performed no more than 6
    months before Visit 1, it will not have to be repeated, provided the
    investigational site reviews and documents a record of the results by
    Visit 2.)
    [10] patients who have signed and dated the informed consent document.
    [1]pacientes varones o mujeres de 18 años de edad o mayores,
    [2]pacientes con diabetes mellitus tipo 2 durante al menos 6 meses en el momento de entrar en el estudio,
    [3]pacientes que han estado tratados con un AO o más a dosis estables durante un mínimo de 6 semanas (12 semanas en el caso de las tiazolidinodionas [TZDs]), Y
    ?han estado tratados con insulina durante 30 días o menos a lo largo de toda su vida y que no han tomado insulina en los últimos 6 meses,Y
    ?son candidatos al tratamiento con insulina, según la opinión del investigador.
    [4]pacientes con niveles de HbA1c ?8,0 y ?10,5% en el momento del cribado,
    ?Si no se cumple el criterio respecto a la HbA1c en la primera visita de cribado, se podrá realizar una nueva prueba de HbA1c al paciente una vez en un período de 3 meses. Si ha transcurrido menos de 1 mes desde el cribado inicial, únicamente se repetirá la prueba de HbA1c. Si ha pasado más de 1 mes, pero menos de 3 meses, se procederá a repetir todo el panel de cribado con la excepción de la cotinina.
    ?Se puede repetir pruebas mientras el período de cribado del estudio no haya terminado en el momento en que se repite la prueba
    [5]si se trata de una paciente no debe estar en período de lactancia,
    y
    si se trata de una paciente en edad fértil (no esterilizada quirúrgicamente y entre la menarquia y 1 año de postmenopausia), debe
    ?dar una prueba negativa de embarazo en el momento del cribado, ya sea en orina o en plasma,
    ?no tener intención de quedarse embarazada durante el estudio,
    y
    ?se comprometen a utilizar durante el estudio un método fiable de control de la natalidad (por ejemplo, anticonceptivos orales o Norplant®; ®; un método de barrera fiable para el control de la natalidad [diafragmas con gel espermicida; condón femenino con gel espermicida; condones con espuma espermicida; dispositivos intrauterinos]; pareja con vasectomía).
    [6]pacientes no fumadores, que no han fumado durante un mínimo de 6 meses antes de su inclusión en el estudio y se comprometen a no fumar (puros, cigarrillos ni en pipa) o mascar tabaco durante el estudio. La concentración de cotinina plasmática debe ser < 20 ng/ml en el momento del cribado,
    ?Si el paciente no fuma durante ? 6 meses, y las concentraciones plasmáticas de cotinina son ? 20 y ? 100 ng/ml, se puede repetir la determinación plasmática de cotinina dentro de un intervalo de 4 semanas.
    ?Pueden repetirse las pruebas mientras el período de cribado para el estudio esté en marcha en el momento de realizar la prueba.
    [7]pacientes capaces de llevar a cabo las pruebas de función pulmonar, de acuerdo con las directrices de la American Thoracic Society (ATS) (ATS, 1995),
    [8]pacientes con PFP clasificadas como ?A,? ?B,? o ?C? respecto a la calidad y que cumplan todos los siguientes criterios para éstas:
    ?DLCO >70% de lo previsto,
    ?FEV1/ FVC > límite inferior normal y FEV1 >70% de lo previsto,
    ?Los pacientes deberían ser capaces de realizar al menos tres FEV1, FVC y maniobras DLCO aceptables, dos de las cuales son reproducibles (dentro de 0,20 l para el FEV1 y la FVC; y dentro de 2,5 unidades estándar DLCO para la DLCO).
    ?Si los pacientes no son capaces de cumplir con los criterios de reproducibilidad para el FEV1, la FVC o las maniobras DLCO, pueden volver para repetir la prueba dentro de un período de 4 semanas.
    ?Si el grado para el FEV1, la FVC o la DLCO es ?D? o "F", los pacientes pueden repetir la prueba durante un período de 4 semanas.
    ?Pueden repetirse las pruebas mientras el período de cribado para el estudio esté en marcha en el momento de realizar la prueba.
    [9]pacientes que tienen una radiografía de tórax (posteroanterior y lateral) sin anomalías pulmonares clínicamente significativas (incluido el enfisema bulloso grave) en opinión del investigador (la esclerosis pulmonar debida a una tuberculosis inactiva no tiene carácter de exclusión). Si se ha hecho una radiografía de tórax (posteroanterior y lateral) durante los últimos 6 meses antes de la visita 1 no habrá que repetirla, siempre que en el centro del estudio se revisen los resultados para la visita 2.
    [10]pacientes que han firmado y fechado el documento de consentimiento informado.
    E.4Principal exclusion criteria
    [11] are investigative site personnel directly affiliated with this study and/or
    their immediate families. Immediate family is defined as a spouse,
    parent, child, or sibling, whether biological or legally adopted,
    [12] are Lilly or Alkermes employees,
    [13] have received treatment within the last 30 days with a drug that has not
    received regulatory approval for any indication at the time of study
    entry,
    [14] patients who have previously received 1 or more doses of any form of
    inhaled insulin, or have previously completed or discontinued from
    this study,
    [15] patients who are taking a TZD dose greater than what is indicated in
    combination with insulin according to the TZD label in the respective
    country (for example, in the United States, rosiglitazone greater than
    4 mg daily or pioglitazone greater than 45 mg daily is not currently
    indicated). In countries where the combination of the TZD and insulin
    is not approved, patients taking any TZD at study entry will be
    excluded,
    [16] patients who have had more than 2 episodes of severe hypoglycemia
    during the 6 months prior to study entry (see Section 5.9 for
    information about severe hypoglycemia),
    [17] patients who have had more than 1 hospitalization or emergency room
    visit due to poor diabetic control during the 6 months prior to study
    entry,
    [18] patients who have had pneumonia in the 3 months prior to screening,
    on clinical or radiologic grounds,
    [19] patients who have received systemic glucocorticoid therapy within the
    3 months prior to study entry (topical preparations, nasal preparations,
    intra-articular administration, as well as physiologic replacement for
    Addison?s Disease and hypopituitarism are permitted),
    [20] patients who have obvious clinical signs or symptoms of liver disease,
    acute or chronic hepatitis, or alanine aminotransaminase/serum
    glutamic pyruvic transaminase (ALT/SGPT) greater than 3 times the
    upper limit of the reference range,
    [21] patients who have a history of renal transplantation, are currently
    receiving renal dialysis, or have a serum creatinine >2.0 mg/dL
    (177 ?mol/L) if not on metformin; or if on metformin at study entry,
    have a serum creatinine above what is contraindicated in the
    metformin label in the respective country (for example, in the United
    States, ?1.5 mg/dL [132 ?mol/L] for males or ?1.4 mg/dL
    [123 ?mol/L] for females),
    [22] patients who have a history of angina, myocardial infarction (MI), or
    Functional Capacity Class III/IV cardiac disease (as defined by the
    New York Heart Association [Protocol Attachment IDAZ.5]) within
    the 6 months prior to study entry,
    [23] patients who have an active or untreated malignancy, or have been in
    remission from a clinically significant malignancy (other than basal
    cell or squamous cell skin cancer, in situ carcinoma of the cervix, or in
    situ prostate cancer) for less than 5 years,
    [24] patients who have a current or past history of lung cancer,
    [25] patients who have a history of lung transplantation,
    [26] patients who have a current diagnosis or past history of asthma,
    chronic obstructive pulmonary disease (COPD), cystic fibrosis,
    bronchiectasis, alpha-1 antitrypsin deficiency, or other clinically
    relevant pulmonary disease that, in the opinion of the investigator,
    would preclude participation in the study due to safety concerns, or
    confound data interpretation,
    [27] patients who are taking or have taken during the prior 6 weeks
    exenatide (Byetta?) or other incretin mimetics that are not approved
    for use with insulin,
    [28] patients who have any other condition (including reported drug abuse,
    alcohol abuse, or psychiatric disorder) that, in the opinion of the
    investigator, precludes the patient from following and completing the
    protocol,
    [29] patients who fail to satisfy the investigator of suitability to participate
    for any other reason.
    [11]ser miembro del personal del centro participante en el estudio directamente afiliado con el presente estudio y/ o miembros de la familia inmediata del mismo. Se define la familia inmediata como esposa/ marido, padre/ madre, hijo/ hija o hermano/ hermana, ya sean miembros biológicos de la familia o adoptados,
    [12]ser empleados de Lilly o de Alkermes,
    [13]haber recibido tratamiento en los últimos 30 días con un fármaco que no haya sido aprobado por los organismos reguladores para ninguna indicación en el momento de ser admitido en el estudio,
    [14]pacientes que hayan recibido 1 dosis o más de cualquier forma de insulina inhalada con anterioridad o que hayan terminado o retirado del presente estudio con anterioridad,
    [15]pacientes que estén tomando una dosis de TZD en combinación con insulina superior a la indicada en la etiqueta de la TZD según lo estipulado en el país correspondiente (por ejemplo, en los Estados Unidos, la rosiglitazona a una dosis superior a los 4 mg al día o pioglitazona por encima de los 45 mg al día no están actualmente indicadas). En países en los que la combinación de TZD e insulina no está aprobada, los pacientes que toman cualquier TZD en el momento de inclusión en el estudio serán excluidos,
    [16]pacientes que hayan tenido más de 2 episodios de hipoglucemia grave en los 6 meses previos a la inclusión en el estudio (véase la Sección 5.9 para datos respecto a la hipoglucemia grave),
    [17]pacientes que hayan sido ingresados en el hospital más de una vez o que hayan acudido a urgencias más de 1 vez debido a un mal control de su diabetes en los 6 meses previos a la inclusión en el estudio,
    [18]pacientes que hayan tenido neumonia en los 3 meses previos al cribado, diagnosticada clínica o radiológicamente,
    [19]pacientes que hayan sido sometidos a terapia sistémica con glucocorticoides en los 3 meses previos a la inclusión en el estudio (se permiten las formulaciones tópicas, nasales y para administración intraarticular, así como la sustitución fisiológica para el tratamiento de la enfermedad de Addison e hipopituitarismo),
    [20]pacientes con signos o síntomas clínicos claros de patología hepática, hepatitis aguda o crónica o alanina aminotransferasa/ transaminasa glutamicopirúvica sérica (ALT/SGPT) más de 3 veces el límite superior del rango de referencia,
    [21]pacientes con antecedentes de transplante renal, que se sometan a diálisis renal en la actualidad o que presenten un nivel de creatinina sérica >2,0 mg/dL (177 ?mol/L) si no toman metformina; o si toman metformina en el momento de inclusión en el estudio, que tengan niveles séricos de creatinina por encima del nivel en el cual queda contraindicada la metformina según su etiqueta en el país correspondiente (por ejemplo, en los Estados Unidos, ?1,5 mg/dL [132 ?mol/L] en el caso de varones o ?1,4 mg/dL [123 ?mol/L] en el caso de mujeres),
    [22]pacientes con antecedentes de angina, infarto de miocardio (IM) o cardiopatía de capacidad funcional de clase Clase III/ IV (de acuerdo con la clasificación de la New York Heart Association [Anexo al Protocolo IDAZ. 5]) en los 6 meses previos a la inclusión en el estudio,
    [23]pacientes que presenten enfermedad maligna activa o no tratada o que lleven menos de 5 años en remisión de una enfermedad maligna clínicamente significativa (que no sea cáncer de piel de células basales o de células escamosas, carcinoma in situ del cuello uterino o cáncer de próstata in situ),
    [24]pacientes con antecedentes actuales o pasados de cáncer de pulmón,
    [25]pacientes con antecedentes de transplante de pulmón,
    [26]pacientes con un diagnóstico actual o antecedentes de asma, enfermedad pulmonar obstructiva crónica (EPOC), fibrosis quística, bronquiectasia, déficit de la alfa-1 antitripsina u otra enfermedad pulmonar relevante que, en opinión del investigador, impediría su participación en el estudio por motivos de seguridad o por que confundiría la interpretación de los datos,
    [27]pacientes que estén tomando o que hayan tomado exenatida (Byetta?) u otros miméticos de la incretina no aprobados para su uso conjuntamente con la insulina en las 6 semanas anteriores,
    [28]pacientes con cualquier otra afección (incluido abuso de fármacos, abuso de alcohol o trastorno psiquiátrico comunicados) que, en opinión del investigador, impida al paciente seguir y finalizar el protocolo,
    [29]pacientes que no satisfagan al investigador respecto a su idoneidad para participar por cualquier otro motivo.
    E.5 End points
    E.5.1Primary end point(s)
    The primary efficacy measure is change in HbA1c from baseline (measured at Visit 3) to the endpoint of each crossover period.
    La medida primaria de eficacia es el cambio de HbA1c respecto al nivel inicial (medido
    en la Visita 3) hasta el final de cada período de cruzado.
    E.5.1.1Timepoint(s) of evaluation of this end point
    24 weeks
    24 semanas
    E.5.2Secondary end point(s)
    The secondary measures of the study are to compare ?HIIP+orals? versus
    ?glargine+orals? with respect to the following parameters:
    ? change in HbA1c from baseline to 12 and 24 weeks,
    ? the proportion of patients who achieve or maintain an HbA1c <7%
    and, in a separate analysis, ?6.5% at 12 weeks and endpoint,
    ? 8-point SMBG profiles at endpoint,
    o preprandial blood glucose measures before morning, midday,
    and evening meals, and overall preprandial blood glucose
    o postprandial blood glucose measures 2 hours after morning,
    midday, and evening meals, and overall postprandial blood
    glucose
    o bedtime blood glucose measure,
    o 3 a.m. blood glucose measure.
    o daily average blood glucose measure.
    o 2-hour blood glucose excursions at endpoint (the difference
    between the preprandial and the 2-hour postprandial blood
    glucose values) for the morning, midday, evening meals, and
    overall 2-hour excursions (based on 8-point SMBG data).
    o M-value (measure of intra-day blood glucose variability).
    o MODD (measure of inter-day blood glucose variability).
    ? Total insulin dose requirements,
    ? fasting lipid profile at endpoint (high-density lipoprotein cholesterol
    [HDL-C], total cholesterol, triglycerides, and low-density lipoprotein
    cholesterol [LDL-C]),
    Human Insulin Inhalation Powder (HIIP) ? Inhaler reliability in patients using HIIP defined by number of inhalers
    returned for patient complaint divided by the number of inhalers dispensed.
    ?glargina+orales? con respecto a los siguientes parámetros:
    ? el cambio de HbA1c producido desde el momento inicial hasta las 12 y
    24 semanas,
    ? la proporción de pacientes que alcanzan o mantienen un nivel de
    HbA1c <7% y, en un análisis aparte, ?6,5%, a las 12 semanas y al
    final,
    ? perfiles de ADGL de 8 puntos en el tiempo predefinido,
    o valores de glucemia preprandial antes de desayuno, comida y
    cena y glucemia preprandial global,
    o valores de glucemia postprandial 2 horas después de desayuno,
    comida y cena y glucemia postprandial global,
    o valores de glucosa en sangre medidos al acostarse,
    o valores de glucosa en sangre medidos a las 3 de la madrugada,
    o promedio de los niveles de glucemia diarios,
    o excursiones de la glucemia a las 2 horas en el tiempo
    predefinido (la diferencia entre la glucemia preprandial y la
    glucemia a las 2 horas postprandial) para desayuno, comida y
    cena y las excursiones globales a las 2 horas (según los datos
    de los ADGL de 8 puntos),
    o el valor M (medida de la variabilidad de la glucemia en un
    mismo día),
    o MVDD (medida de la variabilidad de la glucemia en días
    diferentes).
    Insulina humana en polvo para inhalación (? necesidades totales de insulina (dosis),
    ? perfil de lípidos en ayunas en el tiempo predefinido (colesterol de
    lipoproteínas de alta densidad [HDL-C], colesterol total, triglicéridos y
    colesterol de lipoproteínas de baja densidad [LDL-C]),
    ? fiabilidad del inhalador en los pacientes utilizando la IHPI definida como el
    número de inhaladores devueltos por los pacientes debido a reclamaciones
    dividido por el número de inhaladores dispensados.
    E.5.2.1Timepoint(s) of evaluation of this end point
    24 weeks
    24 semanas
    E.6 and E.7 Scope of the trial
    E.6Scope of the trial
    E.6.1Diagnosis No
    E.6.2Prophylaxis No
    E.6.3Therapy Yes
    E.6.4Safety Yes
    E.6.5Efficacy Yes
    E.6.6Pharmacokinetic No
    E.6.7Pharmacodynamic No
    E.6.8Bioequivalence No
    E.6.9Dose response No
    E.6.10Pharmacogenetic No
    E.6.11Pharmacogenomic No
    E.6.12Pharmacoeconomic No
    E.6.13Others No
    E.7Trial type and phase
    E.7.1Human pharmacology (Phase I) No
    E.7.1.1First administration to humans No
    E.7.1.2Bioequivalence study No
    E.7.1.3Other No
    E.7.1.3.1Other trial type description
    E.7.2Therapeutic exploratory (Phase II) No
    E.7.3Therapeutic confirmatory (Phase III) Yes
    E.7.4Therapeutic use (Phase IV) No
    E.8 Design of the trial
    E.8.1Controlled Yes
    E.8.1.1Randomised Yes
    E.8.1.2Open Yes
    E.8.1.3Single blind No
    E.8.1.4Double blind No
    E.8.1.5Parallel group No
    E.8.1.6Cross over Yes
    E.8.1.7Other No
    E.8.2 Comparator of controlled trial
    E.8.2.1Other medicinal product(s) Yes
    E.8.2.2Placebo No
    E.8.2.3Other Yes
    E.8.2.3.1Comparator description
    Insulina Glargina
    Glargine Insulin
    E.8.2.4Number of treatment arms in the trial2
    E.8.3 The trial involves single site in the Member State concerned No
    E.8.4 The trial involves multiple sites in the Member State concerned Yes
    E.8.4.1Number of sites anticipated in Member State concerned5
    E.8.5The trial involves multiple Member States No
    E.8.6 Trial involving sites outside the EEA
    E.8.6.1Trial being conducted both within and outside the EEA Yes
    E.8.6.2Trial being conducted completely outside of the EEA No
    E.8.6.3If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned
    Brazil
    Indonesia
    United States
    E.8.7Trial has a data monitoring committee No
    E.8.8 Definition of the end of the trial and justification where it is not the last visit of the last subject undergoing the trial
    Last patient visit
    Ultima visita de paciente
    E.8.9 Initial estimate of the duration of the trial
    E.8.9.1In the Member State concerned years1
    E.8.9.1In the Member State concerned months2
    E.8.9.1In the Member State concerned days0
    E.8.9.2In all countries concerned by the trial years1
    E.8.9.2In all countries concerned by the trial months2
    E.8.9.2In all countries concerned by the trial days0
    F. Population of Trial Subjects
    F.1 Age Range
    F.1.1Trial has subjects under 18 No
    F.1.1.1In Utero No
    F.1.1.2Preterm newborn infants (up to gestational age < 37 weeks) No
    F.1.1.3Newborns (0-27 days) No
    F.1.1.4Infants and toddlers (28 days-23 months) No
    F.1.1.5Children (2-11years) No
    F.1.1.6Adolescents (12-17 years) No
    F.1.2Adults (18-64 years) Yes
    F.1.2.1Number of subjects for this age range: 71
    F.1.3Elderly (>=65 years) Yes
    F.1.3.1Number of subjects for this age range: 71
    F.2 Gender
    F.2.1Female Yes
    F.2.2Male Yes
    F.3 Group of trial subjects
    F.3.1Healthy volunteers No
    F.3.2Patients Yes
    F.3.3Specific vulnerable populations Yes
    F.3.3.1Women of childbearing potential not using contraception No
    F.3.3.2Women of child-bearing potential using contraception Yes
    F.3.3.3Pregnant women No
    F.3.3.4Nursing women No
    F.3.3.5Emergency situation No
    F.3.3.6Subjects incapable of giving consent personally No
    F.3.3.7Others No
    F.4 Planned number of subjects to be included
    F.4.1In the member state40
    F.4.2 For a multinational trial
    F.4.2.1In the EEA 40
    F.4.2.2In the whole clinical trial 132
    F.5 Plans for treatment or care after the subject has ended the participation in the trial (if it is different from the expected normal treatment of that condition)
    When the patient will finishes the study, they will follow with the standat treatment for your disease
    Cuando el pacientes termine el estudio, seguira con el tratamiento habitual para si enfermedad.
    G. Investigator Networks to be involved in the Trial
    N. Review by the Competent Authority or Ethics Committee in the country concerned
    N.Competent Authority Decision Authorised
    N.Date of Competent Authority Decision2007-01-12
    N.Ethics Committee Opinion of the trial applicationFavourable
    N.Ethics Committee Opinion: Reason(s) for unfavourable opinion
    N.Date of Ethics Committee Opinion2006-12-12
    P. End of Trial
    P.End of Trial StatusCompleted
    P.Date of the global end of the trial2008-05-29
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