E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Type 2 Diabetes mellitus |
Diabetes Mellitus tipo 2 |
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E.1.1.1 | Medical condition in easily understood language |
Type 2 Diabetes |
Diabetes tipo 2 |
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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 evaluate the effect of lixisenatide versus placebo over a period of 24 weeks on glycemic control, as evaluated by HbA1c reduction, in older type 2 diabetes patients (T2DM) who are inadequately controlled with their current anti-diabetic treatment regimen |
Evaluar el efecto de lixisenatida con respecto a placebo durante 24 semanas sobre el control glucémico, evaluado mediante reducción de la HbA1c, en pacientes mayores con diabetes mellitus tipo 2 (DMT2) inadequadamente controlada con su régimen de tratamiento antidiabético actual |
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E.2.2 | Secondary objectives of the trial |
Main secondary objective: To assess the safety and tolerability of lixisenatide compared to placebo in older T2DM patients (including occurrence of documented (Plasma Glucose PG < 60 mg/dL) symptomatic hypoglycemia and gastrointestinal side effects). Other secondary objectives: To assess the effect of lixisenatide compared to placebo after 24-week treatment on: Fasting plasma glucose (FPG) During liquid standardized breakfast meal challenge test : 2 hour- PPG and Plasma Glucose Excursion 7-point Self-monitored plasma glucose (SMPG) profile Body weight Change in total daily dose of basal insulin (if taken) Percentage of patients requiring rescue therapy Safety and tolerability To assess lixisenatide pharmacokinetic profile To assess anti-lixisenatide antibody development. |
Objetivo secundario principal Evaluar la seguridad y tolerabilidad de lixisenatida con respecto a placebo en pacientes mayores con DMT2 (incluida la aparición de hipoglucemia sintomática [glucosa plasmática GP <60 mg/dl] y efectos secundarios gastrointestinales documentados). Otros objetivos secundarios: Evaluar el efecto de lixisenatida con respecto a placebo después del tratamiento de 24 semanas con: Glucosa plasmática en ayunas (GPA) Durante la prueba de tolerancia al desayuno líquido estandarizado: Glucosa post-prandial (GPP) a las 2 horas y oscilación de la glucosa plasmática El perfil de autocontrol de la glucosa plasmática (Self-monitored plasma glucose, SMPG) de 7 puntos El peso corporal El cambio en la dosis diaria total de insulina basal (si se toma) El porcentaje de pacientes que requieren terapia de rescate Seguridad y tolerabilidad Evaluar el perfil farmacocinético (FC) de lixisenatida Evaluar el desarrollo de anticuerpos antilixisenatida |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
? Older patients, aged 70 years and above, with T2DM inadequately controlled on their current anti-diabetic regimen ? Signed written informed consent |
Pacientes mayores, de más de 70 años de edad, con una DMT2 no controlada con su régimen antidiabético actual. Consentimiento informado por escrito firmado |
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E.4 | Principal exclusion criteria |
? At screening HbA1c ?7.0% or >10% (Acknowledging that the threshold of 7% may not be appropriate for all older patients and that this is the responsibility of the investigator to include the patient based on an individual evaluation of the expected benefits of better glycemic control versus risk of hypoglycemia) ? At screening patients on both basal insulin and sulfonylurea or basal insulin and meglitinides ? At screening FPG >250 mg/dL (>13.9 mmol/L) ? Type 1 diabetes mellitus or history of ketoacidosis within one year prior to the screening visit. ? Type 2 diabetes mellitus diagnosed less than 1 year prior to screening ? Anti-diabetic treatment not at a stable regimen or initiated within the last 3 months prior to screening ? Treatment within the 3 months preceding the screening with other antidiabetic agent than allowed background therapy. Allowed therapy includes metformin, sulfonylurea [except glibenclamide >10mg, glicazide >160mg], meglitinides [except repaglinide >6mg], pioglitazone and basal insulin and should follow local product circulars and labeling restrictions for the study population. . ? Patients who have been on an approved or an investigational GLP-1 medication (exenatide, liraglutide, lixisenatide or others) ? History of severe hypoglycemia associated with symptoms unawareness or results in unconsciousness/coma/seizure in the 6 months prior to screening ? BMI <22 or >40 kg/m² ? Malnutrition assessed clinically by the investigator or any sub-investigator and by MNA-SF score <12 in countries (the judgment of the investigator prevails on questionnaires scores) ? Cognitive disorder and dementia assessed clinically by the investigator or any sub investigator and by MMSE score <24 (the judgment of the investigator prevails on questionnaires scores), or any neurologic disorder that will affect the patient?s ability to participate in the study ? Patient who have an eGFR (using the Modification of Diet in Renal Disease {MDRD} formula <30ml/min/1.73m2 ? Patients with severe or uncontrolled disease, or any clinically significant abnormality identified on physical examination or investigational clinical procedure that, in the judgment of the investigator or any sub-investigator, would preclude safe completion of the study or constrains efficacy assessment ? Laboratory findings at the time of screening: - Amylase and/or lipase: >3 times the upper limit of the normal (ULN) laboratory range - ALT or AST >3 times ULN - Calcitonin >20 pg/mL (5.9 pmol/L) ? Clinically relevant history of gastrointestinal disease associated with prolonged nausea and vomiting, including (but not limited to): gastroparesis, unstable (ie, worsening) and not controlled (ie, prolonged nausea and vomiting) gastroesophageal reflux disease within 6 months prior to screening ? History of unexplained pancreatitis, chronic pancreatitis, pancreatectomy, stomach/gastric surgery, inflammatory bowel disease ? Personal or immediate family history of medullary thyroid cancer or genetic conditions that predisposes to medullary thyroid cancer (eg, multiple endocrine neoplasia syndromes) |
? En la selección, una HbA1c ?7,0 % o >10 % (reconociendo que el umbral del 7 % puede no ser apropiado para todos los pacientes mayores y que es responsabilidad del investigador incluir al paciente según una evaluación individual de los beneficios previstos de un mejor control de la glucemia en comparación con el riesgo de hipoglucemia [consultar la Sección 4.1.4]) ? En la selección, pacientes con insulina basal y sulfonilurea o insulina basal y meglitinidas ? En la selección, GPA >250 mg/dl (>13,9 mmol/l) ? Diabetes mellitus tipo 1 o antecedentes de cetoacidosis en el plazo de un año antes de la visita de selección. ? Diabetes mellitus tipo 2 diagnosticada menos de 1 año antes de la selección ? Tratamiento antidiabético sin régimen estable o iniciado en el plazo de los últimos 3 meses antes de la selección ? Tratamiento en los 3 meses antes de la selección con otro agente antidiabético distinto de la terapia de base permitida. La terapia permitida para la diabetes incluye metformina, sulfonilurea (excepto glibenclamida >10 mg, glicazida >160 mg), meglitinidas (excepto repaglinida >6 mg), pioglitazona e insulina basal y se deben seguir las restricciones de las fichas técnicas y etiquetados locales del producto para la población del estudio. ? Pacientes que han recibido un medicamento de GLP-1 aprobado o en investigación (exenatida, liraglutida, lixisenatida u otros) ? Antecedentes de hipoglucemia severa asociada a inadvertencia de síntomas o que haya causado la pérdida del conocimiento/coma/convulsión en los 6 meses previos a la selección ? IMC <22 o >40 kg/m² ? Desnutrición evaluada clínicamente por el investigador o un subinvestigador y según una puntuación de MNA-SF <12 (el criterio del investigador prevalece sobre las puntuaciones de los cuestionarios) ? Trastorno cognitivo y demencia evaluados clínicamente por el investigador o un subinvestigador, y según la puntuación de MMSE <24 (el criterio del investigador prevalece sobre las puntuaciones de los cuestionarios) o cualquier trastorno neurológico que afecte la capacidad del paciente para participar en el estudio ? Pacientes que tienen una TFGe (utilizando la fórmula de modificación de la dieta en enfermedad renal [Modification of Diet in Renal Disease ,MDRD]) <30 ml/min/1,73 m2 ? Pacientes con enfermedad grave o no controlada, o con cualquier anomalía clínicamente significativa identificada en una exploración física o procedimiento clínico de investigación que, a criterio del investigador o de un subinvestigador, impediría la realización segura del estudio o limitaría la evaluación de eficacia ? Resultados analíticos en el momento de la selección: - Amilasa y/o lipasa: >3 veces por encima del límite superior normal (LSN) del intervalo analítico - ALT o AST >3 veces el LSN - Calcitonina >20 pg/ml (5,9 pmol/l) ? Antecedentes clínicamente relevantes de enfermedad gastrointestinal asociada a náuseas y vómitos prolongados, incluyendo (pero no restringido a): gastroparesia, reflujo gastroesofágico inestable (es decir, empeoramiento) y no controlado (náuseas y vómitos prolongados) en los 6 meses antes de la selección ? Antecedentes de pancreatitis idiopática, pancreatitis crónica, pancreatectomía, cirugía de estómago/gástrica, enfermedad inflamatoria intestinal ? Antecedentes personales o familiares inmediatos de cáncer medular tiroideo o afecciones genéticas que predisponen al cáncer medular tiroideo (p. ej., síndromes de neoplasia endocrina múltiple) |
|
E.5 End points |
E.5.1 | Primary end point(s) |
Change from baseline in HbA1c |
Cambio absoluto en el valor de HbA1c desde el inicio hasta la semana 24 |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
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E.5.2 | Secondary end point(s) |
Change from baseline in FPG
Change in 2?hour PPG and plasma glucose excursions (2-hour postprandial plasma glucose ? FPG) during the liquid standardized breakfast meal test from baseline
Change in 7-point SMPG profile (i.e, the average and each time point of the 7 points) from baseline
Change in body weight from baseline
Change in total daily basal insulin dose from baseline for patients taking basal insulin
Percentage of patients requiring rescue therapy during the 24-week double-blind treatment period
Documented (PG <60 mg/dl) symptomatic hypoglycemia (percentage of subjects with at least one episode, number of events per patient-year)
Severe hypoglycemia
Gastrointestinal side effects |
Cambio en la GPA desde el inicio hasta la semana 24 Cambio en la GPP a las 2 horas y oscilaciones de la glucosa plasmática (glucosa post-prandrial plasmática a las 2 horas ? GPA) durante la prueba del desayuno estandarizado líquido desde el inicio hasta la semana 24 Cambio en el perfil de SMPG de 7 puntos (es decir, el promedio y en cada uno de los 7 puntos) desde el inicio hasta la semana 24 Cambio en el peso corporal desde el inicio hasta la semana 24 Cambio en la dosis de insulina basal diaria total desde el inicio hasta la semana 24 para pacientes que toman insulina basal Porcentaje de pacientes que requieren terapia de rescate durante el período del tratamiento doble ciego de 24 semanas Porcentaje de pacientes que alcanzan HbA1c <7,0 % en la semana 24 Hipoglucemia severa Efectos secundarios gastrointestinales |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
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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 | Yes |
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 | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
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) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
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 | 5 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 42 |
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 |
Bulgaria |
Canada |
Denmark |
Germany |
Norway |
Peru |
Poland |
Russian Federation |
South Africa |
Spain |
Sweden |
United Kingdom |
United States |
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E.8.7 | Trial has a data monitoring committee | Yes |
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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LVLS |
Última visita del último paciente |
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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 | 7 |
E.8.9.1 | In the Member State concerned days | 0 |
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 | 7 |
E.8.9.2 | In all countries concerned by the trial days | 0 |