Clinical Trial Results:
A Multicenter, Randomized, Double-blind, Placebo-controlled, Parallel group, Phase 3 Trial to Evaluate the Safety and Efficacy of Once Weekly Exenatide Therapy Added to Titrated Basal Insulin Glargine Compared to Placebo Added to Titrated Basal Insulin Glargine in Patients with Type 2 Diabetes Who Have Inadequate Glycemic Control on Basal Insulin Glargine with or without Metformin
Summary
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EudraCT number |
2014-003502-33 |
Trial protocol |
SK HU |
Global end of trial date |
29 Aug 2016
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Results information
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Results version number |
v2(current) |
This version publication date |
02 Jan 2019
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First version publication date |
03 Sep 2017
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Other versions |
v1 |
Version creation reason |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
D5553C00002
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT02229383 | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
AstraZeneca
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Sponsor organisation address |
Pepparedsleden 1, Mölndal, Sweden, SE-431 83
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Public contact |
Global Clinical Leader, AstraZeneca, 011 +1 302 885 1180, ClinicalTrialTransparency@astrazeneca.com
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Scientific contact |
Global Clinical Leader, AstraZeneca, 011 +1 302 885 1180, ClinicalTrialTransparency@astrazeneca.com
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
29 Aug 2016
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
29 Aug 2016
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Global end of trial reached? |
Yes
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Global end of trial date |
29 Aug 2016
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Was the trial ended prematurely? |
No
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General information about the trial
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Main objective of the trial |
To compare the change from baseline in hemoglobin A1c (HbA1c) achieved with exenatide once weekly (EQW) added to titrated basal insulin glargine to placebo added to titrated basal insulin glargine, with or without metformin, after 28 weeks of double-blind treatment.
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Protection of trial subjects |
This study was performed in accordance with the ethical principles that have their origin in the Declaration of Helsinki and that are consistent with International Council for Harmonisation/Good Clinical Practice and applicable regulatory requirements and the AstraZeneca policy on Bioethics.
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Background therapy |
Insulin glargine titrated to achieve a target glucose of 4.0 to 5.5 millimoles per liter [72 to 99 milligram per deciliter (mg/dL)]; metformin as prescribed by the Investigator. | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
06 Sep 2014
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
No
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
Hungary: 59
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Country: Number of subjects enrolled |
Poland: 47
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Country: Number of subjects enrolled |
Romania: 45
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Country: Number of subjects enrolled |
Slovakia: 38
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Country: Number of subjects enrolled |
United States: 250
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Country: Number of subjects enrolled |
South Africa: 22
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Worldwide total number of subjects |
461
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EEA total number of subjects |
189
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
353
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From 65 to 84 years |
108
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85 years and over |
0
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Recruitment
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Recruitment details |
This study was conducted in 107 centers globally between 06 September 2014 and 29 August 2016. | |||||||||||||||||||||||||||||||||||||||
Pre-assignment
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Screening details |
The study had a Screening Visit, an 8-week insulin dose optimization phase, followed by a 28-week randomized, double-blind treatment phase. A total of 464 participants were randomized and entered the double-blind Treatment Period. Of which, 3 participants from 1 center in the United States have been excluded from analyses. | |||||||||||||||||||||||||||||||||||||||
Period 1
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Period 1 title |
Overall Study (overall period)
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Is this the baseline period? |
Yes | |||||||||||||||||||||||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Double blind | |||||||||||||||||||||||||||||||||||||||
Roles blinded |
Subject, Investigator, Monitor, Carer, Data analyst, Assessor | |||||||||||||||||||||||||||||||||||||||
Arms
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Are arms mutually exclusive |
Yes
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Arm title
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Exenatide | |||||||||||||||||||||||||||||||||||||||
Arm description |
Exenatide 2 milligram (mg) 1 time per week + titrated basal insulin glargine with or without metformin. | |||||||||||||||||||||||||||||||||||||||
Arm type |
Experimental | |||||||||||||||||||||||||||||||||||||||
Investigational medicinal product name |
Exenatide
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Investigational medicinal product code |
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Other name |
Bydureon
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Pharmaceutical forms |
Powder for injection
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Routes of administration |
Subcutaneous use
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Dosage and administration details |
2 mg one time per week, injection
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Arm title
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Placebo | |||||||||||||||||||||||||||||||||||||||
Arm description |
Placebo (matching with exenatide) 1 time per week + titrated basal insulin glargine with or without metformin. | |||||||||||||||||||||||||||||||||||||||
Arm type |
Placebo | |||||||||||||||||||||||||||||||||||||||
Investigational medicinal product name |
Placebo
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Powder for injection
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Routes of administration |
Subcutaneous use
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Dosage and administration details |
Matching with exenatide one time per week, injection
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Baseline characteristics reporting groups
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Reporting group title |
Exenatide
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Reporting group description |
Exenatide 2 milligram (mg) 1 time per week + titrated basal insulin glargine with or without metformin. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Placebo
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Reporting group description |
Placebo (matching with exenatide) 1 time per week + titrated basal insulin glargine with or without metformin. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Exenatide
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Reporting group description |
Exenatide 2 milligram (mg) 1 time per week + titrated basal insulin glargine with or without metformin. | ||
Reporting group title |
Placebo
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Reporting group description |
Placebo (matching with exenatide) 1 time per week + titrated basal insulin glargine with or without metformin. |
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End point title |
Change in HbA1c From Baseline to Week 28 | ||||||||||||
End point description |
To compare the change from baseline in HbA1c achieved with EQW added to titrated basal insulin glargine to placebo added to titrated basal insulin glargine, with or without metformin, after 28 weeks of double-blind treatment. The ITT analysis set included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline HbA1c assessment. Only participants with data available for analysis are presented.
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End point type |
Primary
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End point timeframe |
Baseline to Week 28
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Statistical analysis title |
Change in HbA1c - baseline to Week 28 | ||||||||||||
Statistical analysis description |
To compare the change from baseline in HbA1c achieved with EQW added to titrated basal insulin glargine to placebo added to titrated basal insulin glargine, with or without metformin, after 28 weeks of double-blind treatment.
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Comparison groups |
Exenatide v Placebo
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Number of subjects included in analysis |
411
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Analysis specification |
Pre-specified
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Analysis type |
superiority [1] | ||||||||||||
P-value |
< 0.001 | ||||||||||||
Method |
Mixed models analysis | ||||||||||||
Parameter type |
Mean difference (final values) | ||||||||||||
Point estimate |
-0.74
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-0.94 | ||||||||||||
upper limit |
-0.54 | ||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
0.101
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Notes [1] - Treatment, region, baseline HbA1c (< or ≥ 9.0%), baseline sulphonylurea (SU)-use, week, treatment by week interaction as fixed factors; baseline value as covariate. |
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End point title |
Change in Body Weight From Baseline to Week 28 | ||||||||||||
End point description |
To compare the change from baseline in body weight achieved with EQW added to titrated basal insulin glargine to placebo added to titrated basal insulin glargine, with or without metformin, after 28 weeks of double-blind treatment. The ITT analysis set included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline HbA1c assessment. Only participants with data available for analysis are presented.
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End point type |
Secondary
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End point timeframe |
Baseline to Week 28
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Statistical analysis title |
Change in body weight - baseline to Week 28 | ||||||||||||
Statistical analysis description |
To compare the change from baseline in body weight achieved with EQW added to titrated basal insulin glargine to placebo added to titrated basal insulin glargine, with or without metformin, after 28 weeks of double-blind treatment.
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Comparison groups |
Exenatide v Placebo
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Number of subjects included in analysis |
413
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Analysis specification |
Pre-specified
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Analysis type |
superiority [2] | ||||||||||||
P-value |
< 0.001 | ||||||||||||
Method |
Mixed models analysis | ||||||||||||
Parameter type |
Mean difference (final values) | ||||||||||||
Point estimate |
-1.52
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-2.19 | ||||||||||||
upper limit |
-0.85 | ||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
0.341
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Notes [2] - Treatment, region, baseline HbA1c (< or ≥ 9.0%), baseline SU-use, week, treatment by week interaction as fixed factors; baseline value as covariate. |
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End point title |
Change From Baseline to Week 28 in 2-hour Postprandial Glucose (PPG) After a Standard Meal Tolerance Test (MTT) | ||||||||||||
End point description |
To compare the change from baseline in 2-hour PPG after a standard MTT achieved with EQW added to titrated basal insulin glargine to placebo added to titrated basal insulin glargine, with or without metformin, after 28 weeks of double-blind treatment. The ITT analysis set included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline HbA1c assessment. Only participants with data available for analysis are presented.
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End point type |
Secondary
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End point timeframe |
Baseline to Week 28
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Statistical analysis title |
Change in 2 hr PPG - baseline to Week 28 | ||||||||||||
Statistical analysis description |
To compare the change from baseline in 2-hour PPG after a standard MTT achieved with EQW added to titrated basal insulin glargine to placebo added to titrated basal insulin glargine, with or without metformin, after 28 weeks of double-blind treatment.
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Comparison groups |
Exenatide v Placebo
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Number of subjects included in analysis |
404
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Analysis specification |
Pre-specified
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Analysis type |
superiority [3] | ||||||||||||
P-value |
< 0.001 | ||||||||||||
Method |
ANCOVA | ||||||||||||
Parameter type |
Mean difference (final values) | ||||||||||||
Point estimate |
-27.76
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-39.07 | ||||||||||||
upper limit |
-16.45 | ||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
5.754
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Notes [3] - Treatment, region, baseline HbA1c (< or ≥ 9.0%), baseline SU-use (yes vs. no) as fixed factors; baseline value as covariate. |
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End point title |
Percentage of Participants Achieving HbA1c <7.0% at Week 28 | ||||||||||||
End point description |
To compare the percentage of participants achieving HbA1c <7.0% between EQW added to titrated basal insulin glargine to placebo added to titrated basal insulin glargine, with or without metformin, after 28 weeks of double-blind treatment. The ITT analysis set included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline HbA1c assessment.
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End point type |
Secondary
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End point timeframe |
Baseline to Week 28
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Statistical analysis title |
Percentage of participants achieving HbA1c <7% | ||||||||||||
Statistical analysis description |
To compare the percentage of participants achieving HbA1c <7.0% between EQW added to titrated basal insulin glargine to placebo added to titrated basal insulin glargine, with or without metformin, after 28 weeks of double-blind treatment.
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Comparison groups |
Exenatide v Placebo
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Number of subjects included in analysis |
458
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Analysis specification |
Pre-specified
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Analysis type |
superiority [4] | ||||||||||||
P-value |
< 0.001 [5] | ||||||||||||
Method |
Cochran-Mantel-Haenszel | ||||||||||||
Confidence interval |
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Notes [4] - Stratified by baseline HbA1c (<9.0% or ≥9.0%) and baseline SU-use (yes vs. no). [5] - Difference in percentages = 25.6 |
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End point title |
Change From Baseline to Week 28 in Daily Insulin Dose | ||||||||||||
End point description |
To compare the change from baseline in daily insulin dose achieved with EQW added to titrated basal insulin glargine to placebo added to titrated basal insulin glargine, with or without metformin, after 28 weeks of double-blind treatment. The ITT analysis set included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline HbA1c assessment. Only participants with data available for analysis are presented.
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End point type |
Secondary
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End point timeframe |
Baseline to Week 28
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Statistical analysis title |
Change in daily insulin dose - baseline to Week 28 | ||||||||||||
Statistical analysis description |
To compare the change from baseline in daily insulin dose achieved with EQW added to titrated basal insulin glargine to placebo added to titrated basal insulin glargine, with or without metformin, after 28 weeks of double-blind treatment.
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Comparison groups |
Exenatide v Placebo
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Number of subjects included in analysis |
417
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Analysis specification |
Pre-specified
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Analysis type |
superiority [6] | ||||||||||||
P-value |
= 0.074 | ||||||||||||
Method |
Mixed models analysis | ||||||||||||
Parameter type |
Mean difference (final values) | ||||||||||||
Point estimate |
-1.9
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Confidence interval |
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level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-4.1 | ||||||||||||
upper limit |
0.2 | ||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
1.08
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Notes [6] - Treatment, region, baseline HbA1c (< or ≥ 9.0%), baseline SU-use, week, treatment by week interaction as fixed factors; baseline value as covariate. |
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End point title |
Percentage of Participants Achieving HbA1c <7.0% at Week 28, No Weight Gain at Week 28, and No Major Hypoglycemia Over 28 Weeks | ||||||||||||
End point description |
To compare the percentage of participants achieving HbA1c <7.0% at Week 28, no weight gain at Week 28, and no major hypoglycemia over 28 weeks between EQW added to titrated basal insulin glargine to placebo added to titrated basal insulin glargine, with or without metformin. The ITT analysis set included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline HbA1c assessment.
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End point type |
Secondary
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End point timeframe |
Baseline to Week 28
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Statistical analysis title |
HbA1c <7.0%, no weight gain or hypoglycemia | ||||||||||||
Statistical analysis description |
To compare the percentage of participants achieving HbA1c <7.0% at Week 28, no weight gain at Week 28, and no major hypoglycemia over 28 weeks between EQW added to titrated basal insulin glargine to placebo added to titrated basal insulin glargine, with or without metformin.
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Comparison groups |
Exenatide v Placebo
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Number of subjects included in analysis |
458
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Analysis specification |
Pre-specified
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Analysis type |
superiority [7] | ||||||||||||
P-value |
< 0.001 [8] | ||||||||||||
Method |
Cochran-Mantel-Haenszel | ||||||||||||
Confidence interval |
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Notes [7] - Stratified by baseline HbA1c (<9.0% or ≥9.0%) and baseline SU-use (yes vs. no). [8] - Difference in percentages = 20.0 |
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End point title |
Change in Seated Systolic Blood Pressure (SBP) From Baseline to Week 28 | ||||||||||||
End point description |
To compare the change from baseline in seated SBP achieved with EQW added to titrated basal insulin glargine to placebo added to titrated basal insulin glargine, with or without metformin, after 28 weeks of double-blind treatment. The ITT analysis set included all randomized participants who received at least 1 dose of study medication and had at least 1 post-baseline HbA1c assessment. Only participants with data available for analysis are presented.
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End point type |
Secondary
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End point timeframe |
Baseline to Week 28
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Statistical analysis title |
Change in SBP - baseline to Week 28 | ||||||||||||
Statistical analysis description |
To compare the change from baseline in seated SBP achieved with EQW added to titrated basal insulin glargine to placebo added to titrated basal insulin glargine, with or without metformin, after 28 weeks of double-blind treatment.
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Comparison groups |
Exenatide v Placebo
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Number of subjects included in analysis |
418
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Analysis specification |
Pre-specified
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Analysis type |
superiority [9] | ||||||||||||
P-value |
= 0.11 | ||||||||||||
Method |
Mixed models analysis | ||||||||||||
Parameter type |
Mean difference (final values) | ||||||||||||
Point estimate |
-1.8
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Confidence interval |
|||||||||||||
level |
95% | ||||||||||||
sides |
2-sided
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lower limit |
-4 | ||||||||||||
upper limit |
0.4 | ||||||||||||
Variability estimate |
Standard error of the mean
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Dispersion value |
1.13
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Notes [9] - Treatment, region, baseline HbA1c (< or ≥ 9.0%), baseline SU-use, week, treatment by week interaction as fixed factors; baseline value as covariate. |
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Adverse events information
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Timeframe for reporting adverse events |
From Baseline (Day 1) up to Week 28
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Adverse event reporting additional description |
Safety analysis set included all participants who received at least 1 dose of randomized study medication. Total number of Deaths is reported for the overall study period, including the off-treatment period; Serious and Non-serious adverse event data is reported for the on-treatment period.
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Assessment type |
Systematic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
19.0
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Reporting groups
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Reporting group title |
Placebo
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Reporting group description |
Placebo (matching with exenatide) 1 time per week + titrated basal insulin glargine with or without metformin. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Exenatide
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Reporting group description |
Exenatide 2 mg 1 time per week + titrated basal insulin glargine with or without metformin. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 5% | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? Yes | |||
Date |
Amendment |
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03 Oct 2014 |
Outcome measure of secondary objective was modified to specify “major” hypoglycemia. Insulin glargine, metformin, and rescue therapy would be sourced locally. Exclusion criterion #25 was included as inclusion criterion #9. Cut off for serum calcitonin concentration was decreased to 40 picogram per milliliter. Tobacco, caffeine, and strenuous exercise were added to list of restrictions 24 hours prior to each visit. Discontinuation procedures were amended to include a review when Investigator deemed it necessary to temporarily stop and re-start study medication. Discontinued participants were required to complete Follow-up visit (Visit 15), and who had symptoms of hypoglycemia were to record glucose measurements and episode details in participant diary. Study Plan updated to clarify when study diary was given out, procedures for collecting study diary, when study medication was dispensed and used/unused medication was collected. Text added to differentiate procedures for Early Termination and Rescue Visits, to indicate IVRS should be called on day of consent, to clarify that participants undergoing rescue therapy were to perform 6 point self-monitored blood glucose profile before returning for Rescue Visit, to indicate that staff monitored study medication administration at study visits, and to indicate when MTTs should be performed. Text regarding MTT updated to include instruction on MTT timing and for how MTT should have been performed. Blood pressure measurement instructions were modified. Investigators should contact medical monitor if a participant developed a liver function test abnormality. Hy’s Law text updated to state that cases meeting any of identification criteria required an unscheduled laboratory draw. Hypoglycemia assessment updated with criteria for classification. Sponsor should have been contacted regarding hypoglycemia events. Added use of SU as a stratification factor for exploratory analyses. Clarified assessment of causality for adverse events. |
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20 Feb 2015 |
The proportion of participants rescued or discontinued for lack of glycemic control at Week 28 was added as an exploratory outcome measure. Inclusion criterion #7 was clarified to state that participants may only take basal insulin glargine once daily. Exclusion criterion #32 was amended to include participation in an interventional clinical trial and to clarify that only administration of an investigational drug would have rendered a participant as ineligible. The Study Plan and Timing of Procedures was updated. This update clarified study visit windows, when used/unused study medication was to be collected, when training for study drug administration was to be received by the participant, and visits when rescue medication could have been dispensed. Review of potential cardiovascular (CV) event triggers was added to all visits where adverse events and concomitant medication were reviewed. Text was added to indicate that metformin should be taken with the next meal, and does not need to be taken at the study center, and that urine should be collected right before time 0 of the MTT. Text was added to indicate that study medication may be dispensed at a Rescue Visit. Text was added to clarify that potential CV event triggers would be reviewed at specified study visits. Text was added to indicate that urine was collected right before time 0 of the MTT. Text was amended to indicate that antibody results would be presented in the CSR. Text was added to clarify that the baseline physical examination data are collection at Visit 1. Text was added to clarify that there is no restriction on fathering children during the study. Text was added to describe the adjudication of CV events. |
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Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
Please note that the data from 4 subjects enrolled at one site were omitted due to potential scientific misconduct at that site. Study conclusions remain unchanged. |