E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Diseases [C] - Nutritional and Metabolic Diseases [C18] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 14.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10067585 |
E.1.2 | Term | Type 2 diabetes mellitus |
E.1.2 | System Organ Class | 10027433 - Metabolism and nutrition disorders |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To confirm the efficacy of insulin degludec/liraglutide in controlling glycaemia in subjects with type 2 diabetes.
This is done by comparing the difference in change in HbA1c from baseline after 26 weeks of treatment to a non-inferiority limit of 0.3% for insulin degludec/liraglutide vs insulin degludec and to a superiority limit of 0% for insulin degludec/liraglutide vs liraglutide. |
Confirmar la eficacia de insulina degludec/liraglutida para el control de la glucemia en pacientes con diabetes tipo 2.
A este fin, se comparará la diferencia en el cambio en la HbA1c con respecto al valor basal después de 26 semanas de tratamiento con un límite de no inferioridad del 0,3% para insulina degludec/liraglutida frente a insulina degludec y un límite de superioridad del 0% para insulina degluded/liraglutida frente a liraglutida |
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E.2.2 | Secondary objectives of the trial |
To confirm superiority of insulin degludec/liraglutide vs insulin degludec after 26 weeks of treatment on either weight control, hypoglycaemic episodes, glycaemic control in relation to a meal, or glycaemic control as indirectly measured by daily dose of insulin degludec To compare general efficacy and safety of insulin degludec/liraglutide, insulin degludec and liraglutide after 26 and 52 weeks of treatment To confirm the efficacy of insulin degludec/liraglutide in controlling glycaemia in subjects with type 2 diabetes after 52 weeks of treatment |
Confirmar la superioridad de insulina degludec/liraglutida frente a la insulina degludec después de 26 semanas de tratamiento bien con respecto al control del peso corporal y los episodios de hipoglucemia, control glucémico en relación con una comida o control glucémico indirectamente medido por dosis diarias de insulina degludec. Confirmar la eficacia de insulina degludec/liraglutida para el control de la glucemia en pacientes con diabetes tipo 2 después de 52 semanas de tratamiento Comparar la eficacia general y la seguridad de insulina degludec/liraglutida, insulina degludec y liraglutida después de 26 y 52 semanas de tratamiento |
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E.2.3 | Trial contains a sub-study | Yes |
E.2.3.1 | Full title, date and version of each sub-study and their related objectives |
Titulo:Documento adjunto para el subestudio del ensayo clínico NN9068-3697 Fecha: 09 de Junio de 2011 Versión 2.0 Objectivo: Confirmar la superioridad de insulina degludec/liraglutida frente a insulina degludec después de 52 semanas de tratamiento en el control glucémico en relación con una comida y comparar la eficacia general y la seguridad de insulina degludec/liraglutida, insulina degludec y liraglutida después de 52 semanas de tratamiento |
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E.3 | Principal inclusion criteria |
Pacientes con diabetes tipo 2 HbA1c: 7,0-10,0 % (ambos inclusive) con el objetivo de una media de HbA1c del 8.3%. Consecuentemente cuando aproximadamente el 50% de los sujetos randomizados tengan una . HbA1c por encima de 8.3%, el resto de sujetos que queden por randomizar deberán tener una HbA1c por debajo o igual a 8.3%, o cuando aproximadamente el 50% de los pacientes randomizados tengan una HbA1c por debajo o igual al 8.3%, el resto de pacientes que queden por randomizar deberán tener una HbA1c por encima de 8.3%. Hombres o mujeres de 18 o más años de edad Pacientes con una dosis estable de uno o dos ADO (metformina [ > ó = 1.500 mg o la dosis máxima tolerada] o metformina [> ó = 1.500 mg o la dosis máxima tolerada] + pioglitazona [> ó = 30 mg]) durante al menos 90 días antes de la visita de selección IMC < ó = 40 Kg/m2
- Subjects with type 2 diabetes - HbA1c 7.0-10.0 % (both inclusive) with the aim of a median HbA1c of 8.3%. Accordingly, when approximately 50% of the randomised subjects have a HbA1c above 8.3%, the remaining subjects randomised must have a HbA1c of below or equal to 8.3%, or when approximately 50% of the randomised subjects have a HbA1c of below or equal to 8.3%, the remaining subjects randomised must have a HbA1c above 8.3% - Male or female, age 18 years or above -Subjects on stable dose of 1-2 OADs (metformin [>or = 1500 mg or max tolerated dose] or metformin [> or = 1500 mg or max tolerated dose] + pioglitazone [> or = 30 mg]) for at least 90 days prior to screening -BMI < or = 40 kg/m^2 |
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E.4 | Principal exclusion criteria |
Tratamiento con insulina (excepto tratamientos cortos debidos a enfermedades intercurrentes, a juicio del investigador) Tratamiento con agonistas de receptores GLP-1( ej exenatida, liraglutida),sulfonilureas o inhibidores de la dipeptidilo peptidasa 4 (DPP-4) en los 90 día anteriores al inicio del ensayo clínico Alteraciones de la función hepática, definidas como niveles de alanina aminotransferasa (ALAT) > ó = 2,5 veces el límite normal superior (LNS) (se permite volver a realizar la prueba en el laboratorio central en el plazo máximo de una semana a contar desde la obtención de la primera muestra, en cuyo caso se considerará que el resultado definitivo es el segundo) Alteraciones de la función renal que se define como una concentración sérica de creatinina > ó = 133 micromol/l (> ó = 1,5 mg/dl) para los hombres y > ó = 125 micromol/l ( 1,4) para las mujeres, o la concentración que se permita según las contraindicaciones de cada país de la metformina (se permite realizar una segunda prueba en el laboratorio central en el plazo máximo de una semana a contar desde la obtención de la primera muestra, en cuyo caso el resultado definitivo será el segundo) Calcitonina en la visita de selección > ó = 50 ng/L Pacientes con antecedentes personales o familiares de carcinoma medular de tiroides (CMT) o de neoplasia endocrina múltiple tipo 2 (NEM-2) Cardiopatía, que se define como insuficiencia cardíaca congestiva (clase III-IV de la NYHA) diagnóstico de angina de pecho inestable, accidente cerebrovascular y/o infarto de miocardio en los 12 meses anteriores o procedimientos programados de revascularización coronaria, carotídea o de las arterias periféricas. Hipertensión arterial grave y no controlada, tratada o no tratada (presión arterial sistólica > ó = 180 mmHg o presión arterial diastólica > ó = 100 mmHg) Tratamiento agudo requerido para retinopatía proliferativa o maculopatía (edema macular) Antecedentes de pancreatitis crónica o de pancreatitis aguda idiopática.
Treatment with insulin (except for short-term treatment due to intercurrent illness at the discretion of the Investigator) Treatment with GLP-1 receptor agonists (eg exenatide, liraglutide), sulphonylurea or dipeptidyl peptidase 4 (DPP-4) inhibitors within 90 days prior to trial Impaired liver function, defined as alanine aminotransferese (ALAT) > or = 2.5 times Upper Normal Range (UNR) (one retest analysed at the central laboratory within a week from first sample taken is permitted with the result of the last sample being the conclusive) Impaired renal function defined as serum-creatinine > or = 133 micromol/l > or = 1.5 mg/dl) for males and > or = 125 micromol/l (> or = 1.4) for females, or as allowed according to local contraindications for metformin (one retest analysed at the central laboratory within a week from first sample taken is permitted with the result of the last sample being the conclusive) Screening calcitonin > or = 50 ng/L Subjects with personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia type 2 (MEN 2) Cardiac disorder defined as: congestive heart failure (NYHA class III-IV), diagnosis of unstable angina pectoris, cerebral stroke and/or myocardial infarction within the last 12 months and planned coronary, carotid or peripheral artery revascularisation procedures Severe uncontrolled treated or untreated hypertension (systolic blood pressure > or = 180 mm Hg or diastolic blood pressure > or = 100 mm Hg) Acute treatment required proliferative retinopathy or maculopathy (macular oedema) History of chronic pancreatitis or idiopathic acute pancreatitis micro |
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E.5 End points |
E.5.1 | Primary end point(s) |
Cambio en los niveles basales de HbA1c después de 26 semanas de tratamiento Change from baseline in HbA1c after 26 weeks of treatment |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
después de 26 semanas de tratamiento after 26 weeks of treatment |
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E.5.2 | Secondary end point(s) |
To confirm superiority of insulin degludec/liraglutide vs. insulin degludec the following confirmatory endpoints will be used: ?Change from baseline in body weight after 26 weeks of treatment ?Number of severe or minor hypoglycaemic episodes after 26 weeks of treatment ?Change from baseline in incremental AUC0-4h (iAUC 0-4h) derived from the glucose concentration profile during meal test after 26 weeks of treatment (see sub-study addendum) ?Daily insulin dose after 26 weeks of treatment |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
after 26 weeks of treatment |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | Yes |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 3 |
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.8.4.1 | Number of sites anticipated in Member State concerned | 8 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 72 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Australia |
Canada |
India |
Malaysia |
Mexico |
Russian Federation |
Singapore |
South Africa |
Taiwan |
Thailand |
United States |
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E.8.7 | Trial 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
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 4 |
E.8.9.1 | In the Member State concerned days | 7 |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 4 |
E.8.9.2 | In all countries concerned by the trial days | 7 |