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Safety and Efficacy of Bexagliflozin Compared to Glimepiride as Add-on Therapy to Metformin in Type 2 Diabetes Subjects

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT02769481
Recruitment Status : Completed
First Posted : May 11, 2016
Results First Posted : May 27, 2021
Last Update Posted : May 27, 2021
Sponsor:
Information provided by (Responsible Party):
Theracos

Study Type Interventional
Study Design Allocation: Randomized;   Intervention Model: Parallel Assignment;   Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor);   Primary Purpose: Treatment
Condition Type 2 Diabetes Mellitus
Interventions Drug: Bexagliflozin
Drug: Placebo for Bexagliflozin
Drug: Glimepiride
Drug: Placebo for Glimepiride
Enrollment 426
Recruitment Details  
Pre-assignment Details  
Arm/Group Title Bexagliflozin Glimepiride
Hide Arm/Group Description

Subjects will receive a bexagliflozin tablet, 20 mg, once daily for the duration of the study. Subjects will continue taking metformin and receive placebo for glimepiride for the duration of the study.

Bexagliflozin tablets: 20 mg

Glimepiride capsules: Placebo, inactive capsule to match the active comparator

Subjects will receive a glimepiride capsule, 2, 4 or 6 mg, once daily for the duration of the study. Subjects will continue taking metformin and receive placebo for bexagliflozin for the duration of the study.

Bexagliflozin: Placebo, inactive tablet to match the active comparator

Glimepiride capsules: 2, 4 or 6 mg

Period Title: Overall Study
Started 213 213
Study Complete at Week 60 193 192
Completed 180 177
Not Completed 33 36
Reason Not Completed
Protocol Violation             1             0
Adverse Event             3             6
Entry Criteria Not Met             1             2
Withdrawal by Subject             14             16
Lost to Follow-up             9             9
Physician Decision             0             1
Terminated by Sponsor             1             0
Death             0             1
Undefined             4             1
Arm/Group Title Bexagliflozin Glimepiride Total
Hide Arm/Group Description

Subjects will receive a bexagliflozin tablet, 20 mg, once daily for the duration of the study. Subjects will continue taking metformin and receive placebo for glimepiride for the duration of the study.

Bexagliflozin tablets: 20 mg

Glimepiride capsules: Placebo, inactive capsule to match the active comparator

Subjects will receive a glimepiride capsule, 2, 4 or 6 mg, once daily for the duration of the study. Subjects will continue taking metformin and receive placebo for bexagliflozin for the duration of the study.

Bexagliflozin: Placebo, inactive tablet to match the active comparator

Glimepiride capsules: 2, 4 or 6 mg

Total of all reporting groups
Overall Number of Baseline Participants 213 213 426
Hide Baseline Analysis Population Description
[Not Specified]
Age, Continuous  
Mean (Standard Deviation)
Unit of measure:  Years
Number Analyzed 213 participants 213 participants 426 participants
59.5  (9.06) 59.7  (10.35) 59.6  (9.71)
Sex: Female, Male  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 213 participants 213 participants 426 participants
Female
95
  44.6%
83
  39.0%
178
  41.8%
Male
118
  55.4%
130
  61.0%
248
  58.2%
Ethnicity (NIH/OMB)  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 213 participants 213 participants 426 participants
Hispanic or Latino
46
  21.6%
47
  22.1%
93
  21.8%
Not Hispanic or Latino
167
  78.4%
166
  77.9%
333
  78.2%
Unknown or Not Reported
0
   0.0%
0
   0.0%
0
   0.0%
Race (NIH/OMB)  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 213 participants 213 participants 426 participants
American Indian or Alaska Native
0
   0.0%
0
   0.0%
0
   0.0%
Asian
9
   4.2%
4
   1.9%
13
   3.1%
Native Hawaiian or Other Pacific Islander
1
   0.5%
0
   0.0%
1
   0.2%
Black or African American
5
   2.3%
4
   1.9%
9
   2.1%
White
198
  93.0%
204
  95.8%
402
  94.4%
More than one race
0
   0.0%
0
   0.0%
0
   0.0%
Unknown or Not Reported
0
   0.0%
1
   0.5%
1
   0.2%
Region of Enrollment  
Measure Type: Number
Unit of measure:  Participants
Number Analyzed 213 participants 213 participants 426 participants
United States 65 63 128
Poland 74 79 153
Germany 28 29 57
Spain 46 42 88
Height  
Mean (Standard Deviation)
Unit of measure:  Cm
Number Analyzed 213 participants 213 participants 426 participants
166.7  (11.13) 167.1  (9.53) 166.9  (10.35)
Body Weight at Baseline  
Mean (Standard Deviation)
Unit of measure:  Kg
Number Analyzed 213 participants 213 participants 426 participants
87.95  (19.122) 90.23  (17.616) 89.09  (18.399)
BMI  
Mean (Standard Deviation)
Unit of measure:  Kg/m^2
Number Analyzed 213 participants 213 participants 426 participants
31.45  (4.861) 32.22  (5.155) 31.83  (5.019)
Systolic Blood Pressure at Baseline  
Mean (Standard Deviation)
Unit of measure:  Mm Hg
Number Analyzed 213 participants 213 participants 426 participants
133.3  (14.88) 134.2  (14.37) 133.8  (14.62)
Systolic Blood Pressure Categories  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 213 participants 213 participants 426 participants
< 140 mm Hg
135
  63.4%
138
  64.8%
273
  64.1%
> 140 mm Hg
78
  36.6%
75
  35.2%
153
  35.9%
1.Primary Outcome
Title Change From Baseline in HbA1c at Week 60
Hide Description The primary objective is to demonstrate that bexagliflozin is non-inferior to glimepiride by evaluating the treatment effect on HbA1c reduction at week 60 in subjects whose T2DM is inadequately controlled by metformin. The least square mean (LSM) change from baseline to Week 60 was analyzed using a mixed model repeated measures (MMRM) analysis of covariance model (ANCOVA).
Time Frame Baseline and Week 60
Hide Outcome Measure Data
Hide Analysis Population Description
The intention-to-treat population was used for the analysis. Subjects with a value at baseline and at week 60 were analyzed.
Arm/Group Title Bexagliflozin Glimepiride
Hide Arm/Group Description:

Subjects will receive a bexagliflozin tablet, 20 mg, once daily for the duration of the study. Subjects will continue taking metformin and receive placebo for glimepiride for the duration of the study.

Bexagliflozin tablets: 20 mg

Glimepiride capsules: Placebo, inactive capsule to match the active comparator

Subjects will receive a glimepiride capsule, 2, 4 or 6 mg, once daily for the duration of the study. Subjects will continue taking metformin and receive placebo for bexagliflozin for the duration of the study.

Bexagliflozin: Placebo, inactive tablet to match the active comparator

Glimepiride capsules: 2, 4 or 6 mg

Overall Number of Participants Analyzed 193 191
Least Squares Mean (Standard Error)
Unit of Measure: percentage of glycated hemoglin
-0.70  (0.058) -0.66  (0.058)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Bexagliflozin, Glimepiride
Comments The null hypothesis for the primary endpoint was that the change in HbA1c from baseline to week 60 in the bexagliflozin arm would be greater than change in the glimepiride arm by greater than 0.35%.
Type of Statistical Test Non-Inferiority
Comments A 95% CI was to be calculated to estimate the range of values in which the treatment difference was likely to lie. If the 95% CI fell below the specified non inferiority margin of 0.35%, the non inferiority of bexagliflozin treatment to glimepiride treatment would be demonstrated and the null hypothesis would be rejected.
Method of Estimation Estimation Parameter Mean Difference (Final Values)
Estimated Value 0.05
Confidence Interval (2-Sided) 95%
-0.21 to 0.11
Estimation Comments A lower value represents a better treatment effect.
2.Secondary Outcome
Title Change From Baseline in Body Weight at Week 60 for Subjects With Baseline BMI ≥ 25 kg/m2
Hide Description Least squares (LS) mean treatment difference between the bexagliflozin group and placebo group in the change of body weight in subjects with baseline BMI ≥ 25 kg/m2 at week 60 is analyzed using ANCOVA.
Time Frame Baseline and 60 weeks
Hide Outcome Measure Data
Hide Analysis Population Description
Number of subjects with a value at baseline and at the specified visit
Arm/Group Title Bexagliflozin Glimepiride
Hide Arm/Group Description:

Subjects will receive a bexagliflozin tablet, 20 mg, once daily for the duration of the study. Subjects will continue taking metformin and receive placebo for glimepiride for the duration of the study.

Bexagliflozin tablets: 20 mg

Glimepiride capsules: Placebo, inactive capsule to match the active comparator

Subjects will receive a glimepiride capsule, 2, 4 or 6 mg, once daily for the duration of the study. Subjects will continue taking metformin and receive placebo for bexagliflozin for the duration of the study.

Bexagliflozin: Placebo, inactive tablet to match the active comparator

Glimepiride capsules: 2, 4 or 6 mg

Overall Number of Participants Analyzed 182 182
Least Squares Mean (Standard Error)
Unit of Measure: kg
-3.71  (0.285) 0.59  (0.284)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Bexagliflozin, Glimepiride
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value < 0.0001
Comments P-value is based on one sided statistical tests using a 0.025 level of significance.
Method Mixed-effects repeated measures
Comments Region, background treatment, baseline HbA1c, baseline eGFR, treatment, visit, treatment-by-visit and baseline weight as a fixed effect covariate.
Method of Estimation Estimation Parameter Difference of LS Means
Estimated Value -4.31
Confidence Interval (2-Sided) 95%
-5.10 to -3.52
Estimation Comments [Not Specified]
3.Secondary Outcome
Title Change From Baseline in Systolic Blood Pressure (SBP) at Week 60 for Subjects With Baseline SBP ≥ 140 mmHg
Hide Description Least squares (LS) mean treatment difference between the bexagliflozin group and placebo group in the change of SBP in subjects with baseline SBP ≥ 140 mmHg at week 60 is analyzed using ANCOVA.
Time Frame Baseline and 60 weeks
Hide Outcome Measure Data
Hide Analysis Population Description
[Not Specified]
Arm/Group Title Bexagliflozin Glimepiride
Hide Arm/Group Description:

Subjects will receive a bexagliflozin tablet, 20 mg, once daily for the duration of the study. Subjects will continue taking metformin and receive placebo for glimepiride for the duration of the study.

Bexagliflozin tablets: 20 mg

Glimepiride capsules: Placebo, inactive capsule to match the active comparator

Subjects will receive a glimepiride capsule, 2, 4 or 6 mg, once daily for the duration of the study. Subjects will continue taking metformin and receive placebo for bexagliflozin for the duration of the study.

Bexagliflozin: Placebo, inactive tablet to match the active comparator

Glimepiride capsules: 2, 4 or 6 mg

Overall Number of Participants Analyzed 74 68
Least Squares Mean (Standard Error)
Unit of Measure: mm Hg
-13.48  (1.404) -6.95  (1.460)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Bexagliflozin, Glimepiride
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.0008
Comments P-value is based on one sided statistical tests using a 0.025 level of significance.
Method Mixed-effects repeated measures
Comments Region, background treatment, baseline HbA1c, baseline eGFR, treatment, visit, treatment-by-visit and baseline weight as a fixed effect covariate.
Method of Estimation Estimation Parameter Difference of LS Means
Estimated Value -6.53
Confidence Interval (2-Sided) 95%
-10.56 to -2.51
Estimation Comments [Not Specified]
4.Secondary Outcome
Title Difference in Proportion of Subjects With ≥ 1 Severe or Documented Symptomatic Hypoglycemia Events Over 96 Weeks
Hide Description The difference in proportion of subjects with ≥ 1 severe or documented symptomatic hypoglycemia events in the bexagliflozin group compared with glimepiride group over 96 weeks is analyzed using a logistic regression model. The full model included region, baseline HbA1c value, background treatment status (metformin or metformin + OHA), eGFR at baseline ≥ 90 or < 90 mL min 1 per 1.73 m2), treatment as a fixed effect covariate.
Time Frame During the 96 week treatment period
Hide Outcome Measure Data
Hide Analysis Population Description
Subjects with post-baseline assessment.
Arm/Group Title Bexagliflozin Glimepiride
Hide Arm/Group Description:

Subjects will receive a bexagliflozin tablet, 20 mg, once daily for the duration of the study. Subjects will continue taking metformin and receive placebo for glimepiride for the duration of the study.

Bexagliflozin tablets: 20 mg

Glimepiride capsules: Placebo, inactive capsule to match the active comparator

Subjects will receive a glimepiride capsule, 2, 4 or 6 mg, once daily for the duration of the study. Subjects will continue taking metformin and receive placebo for bexagliflozin for the duration of the study.

Bexagliflozin: Placebo, inactive tablet to match the active comparator

Glimepiride capsules: 2, 4 or 6 mg

Overall Number of Participants Analyzed 213 212
Measure Type: Number
Number (95% Confidence Interval)
Unit of Measure: Proportion of participants
0.02
(0.01 to 0.05)
0.15
(0.10 to 0.22)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Bexagliflozin, Glimepiride
Comments [Not Specified]
Type of Statistical Test Superiority
Comments [Not Specified]
Statistical Test of Hypothesis P-Value < 0.0001
Comments P-value is based on one sided statistical tests using a 0.025 level of significance.
Method Regression, Logistic
Comments Region, baseline HbA1c, background treatment, eGFR at baseline, treatment as a fixed effect covariate.
Method of Estimation Estimation Parameter Odds Ratio (OR)
Estimated Value 0.12
Confidence Interval (2-Sided) 95%
0.05 to 0.28
Estimation Comments Odds ratio is calculated as the odds ratio of bexagliflozin over glimepiride.
5.Secondary Outcome
Title Superiority of Bexagliflozin Over Glimepiride in HbA1c Reduction at Week 60.
Hide Description Superiority of bexagliflozin over glimepiride in HbA1c reduction from baseline to week 60 will be declared if the upper bound of 95% CI is less than 0.
Time Frame Baseline to Week 60
Hide Outcome Measure Data
Hide Analysis Population Description
The intention-to-treat population was used for the analysis. Subjects with a value at baseline and at week 60 were analyzed.
Arm/Group Title Bexagliflozin Glimepiride
Hide Arm/Group Description:

Subjects will receive a bexagliflozin tablet, 20 mg, once daily for the duration of the study. Subjects will continue taking metformin and receive placebo for glimepiride for the duration of the study.

Bexagliflozin tablets: 20 mg

Glimepiride capsules: Placebo, inactive capsule to match the active comparator

Subjects will receive a glimepiride capsule, 2, 4 or 6 mg, once daily for the duration of the study. Subjects will continue taking metformin and receive placebo for bexagliflozin for the duration of the study.

Bexagliflozin: Placebo, inactive tablet to match the active comparator

Glimepiride capsules: 2, 4 or 6 mg

Overall Number of Participants Analyzed 193 191
Least Squares Mean (Standard Error)
Unit of Measure: percentage of glycated hemoglobin
-0.70  (0.058) -0.66  (0.058)
Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Bexagliflozin, Glimepiride
Comments [Not Specified]
Type of Statistical Test Superiority
Comments Superiority of bexagliflozin over glimepiride in HbA1c reduction from baseline to week 60 will be declared if the upper bound of 95% confidence interval is less than 0
Method of Estimation Estimation Parameter Difference of LS Means
Estimated Value -0.05
Confidence Interval (2-Sided) 95%
-0.21 to 0.11
Estimation Comments [Not Specified]
Time Frame Adverse event data was collected from Week -8 (V2, wash-out) to Week 98 (V18, follow-up).
Adverse Event Reporting Description [Not Specified]
 
Arm/Group Title Bexagliflozin Glimepiride
Hide Arm/Group Description

Subjects will receive a bexagliflozin tablet, 20 mg, once daily for the duration of the study. Subjects will continue taking metformin and receive placebo for glimepiride for the duration of the study.

Bexagliflozin tablets: 20 mg

Glimepiride capsules: Placebo, inactive capsule to match the active comparator

Subjects will receive a glimepiride capsule, 2, 4 or 6 mg, once daily for the duration of the study. Subjects will continue taking metformin and receive placebo for bexagliflozin for the duration of the study.

Bexagliflozin: Placebo, inactive tablet to match the active comparator

Glimepiride capsules: 2, 4 or 6 mg

All-Cause Mortality
Bexagliflozin Glimepiride
Affected / at Risk (%) Affected / at Risk (%)
Total   0/213 (0.00%)   1/213 (0.47%) 
Hide Serious Adverse Events
Bexagliflozin Glimepiride
Affected / at Risk (%) Affected / at Risk (%)
Total   25/213 (11.74%)   26/213 (12.21%) 
Cardiac disorders     
Acute myocardial infarction  1  2/213 (0.94%)  1/213 (0.47%) 
Myocardial ischemia  1  1/213 (0.47%)  2/213 (0.94%) 
Acute coronary syndrome  1  1/213 (0.47%)  1/213 (0.47%) 
Angina unstable  1  0/213 (0.00%)  1/213 (0.47%) 
Bradycardia  1  0/213 (0.00%)  1/213 (0.47%) 
Cardiac failure congestive  1  0/213 (0.00%)  1/213 (0.47%) 
Myocardial infarction  1  0/213 (0.00%)  1/213 (0.47%) 
Myocarditis  1  1/213 (0.47%)  0/213 (0.00%) 
Palpitation  1  1/213 (0.47%)  0/213 (0.00%) 
Congenital, familial and genetic disorders     
Phimosis  1  1/213 (0.47%)  0/213 (0.00%) 
Ear and labyrinth disorders     
Deafness unilateral  1  0/213 (0.00%)  1/213 (0.47%) 
Eye disorders     
Ectropion  1  1/213 (0.47%)  0/213 (0.00%) 
Entropion  1  1/213 (0.47%)  0/213 (0.00%) 
Retinal detachment  1  0/213 (0.00%)  1/213 (0.47%) 
Gastrointestinal disorders     
Faecaloma  1  1/213 (0.47%)  0/213 (0.00%) 
Inguinal hernia  1  1/213 (0.47%)  0/213 (0.00%) 
Small intestinal obstruction  1  0/213 (0.00%)  1/213 (0.47%) 
General disorders     
Non-cardiac chest pain  1  1/213 (0.47%)  0/213 (0.00%) 
Hepatobiliary disorders     
Cholelithiasis  1  1/213 (0.47%)  1/213 (0.47%) 
Infections and infestations     
Pneumonia  1  2/213 (0.94%)  2/213 (0.94%) 
Erysipelas  1  0/213 (0.00%)  1/213 (0.47%) 
Otitis media chronic  1  0/213 (0.00%)  1/213 (0.47%) 
Pyelonephritis acute  1  1/213 (0.47%)  0/213 (0.00%) 
Metabolism and nutrition disorders     
Hyponatremia  1  0/213 (0.00%)  1/213 (0.47%) 
Musculoskeletal and connective tissue disorders     
Osteoarthritis  1  1/213 (0.47%)  1/213 (0.47%) 
Osteochondrosis  1  0/213 (0.00%)  1/213 (0.47%) 
Polyarthritis  1  1/213 (0.47%)  0/213 (0.00%) 
Spinal osteoarthritis  1  1/213 (0.47%)  0/213 (0.00%) 
Ankle fracture  1  0/213 (0.00%)  1/213 (0.47%) 
Contusion  1  1/213 (0.47%)  0/213 (0.00%) 
Muscle rupture  1  1/213 (0.47%)  0/213 (0.00%) 
Tibia fracture  1  0/213 (0.00%)  1/213 (0.47%) 
Neoplasms benign, malignant and unspecified (incl cysts and polyps)     
Rectal adenocarcinoma  1  1/213 (0.47%)  0/213 (0.00%) 
Small cell lung cancer  1  0/213 (0.00%)  1/213 (0.47%) 
Nervous system disorders     
Transient ischemic attack  1  1/213 (0.47%)  1/213 (0.47%) 
Carotid artery stenosis  1  1/213 (0.47%)  0/213 (0.00%) 
Cerebrovascular accident  1  1/213 (0.47%)  0/213 (0.00%) 
Ischemic stroke  1  0/213 (0.00%)  1/213 (0.47%) 
Nervous system disorder  1  0/213 (0.00%)  1/213 (0.47%) 
Thalamic infarction  1  1/213 (0.47%)  0/213 (0.00%) 
Renal and urinary disorders     
Nephrolithiasis  1  0/213 (0.00%)  2/213 (0.94%) 
Bladder disorder  1  0/213 (0.00%)  1/213 (0.47%) 
Reproductive system and breast disorders     
Genital hemorrhage  1  0/213 (0.00%)  1/213 (0.47%) 
Uterine prolapse  1  1/213 (0.47%)  0/213 (0.00%) 
Skin and subcutaneous tissue disorders     
Dermatitis  1  0/213 (0.00%)  1/213 (0.47%) 
Ecchymosis  1  0/213 (0.00%)  1/213 (0.47%) 
Vascular disorders     
Arterial occlusive disease  1  0/213 (0.00%)  1/213 (0.47%) 
1
Term from vocabulary, MedDRA 19.0
Indicates events were collected by systematic assessment
Hide Other (Not Including Serious) Adverse Events
Frequency Threshold for Reporting Other Adverse Events 5%
Bexagliflozin Glimepiride
Affected / at Risk (%) Affected / at Risk (%)
Total   98/213 (46.01%)   112/213 (52.58%) 
Infections and infestations     
Nasopharyngitis  1  29/213 (13.62%)  29/213 (13.62%) 
Urinary Tract Infection  1  25/213 (11.74%)  10/213 (4.69%) 
Bronchitis  1  14/213 (6.57%)  16/213 (7.51%) 
Metabolism and nutrition disorders     
Hypoglycemia  1  36/213 (16.90%)  71/213 (33.33%) 
Diabetes mellitus inadequate control  1  1/213 (0.47%)  17/213 (7.98%) 
Musculoskeletal and connective tissue disorders     
Back pain  1  6/213 (2.82%)  16/213 (7.51%) 
Arthralgia  1  13/213 (6.10%)  4/213 (1.88%) 
1
Term from vocabulary, MedDRA 19.0
Indicates events were collected by systematic assessment
Certain Agreements
Principal Investigators are NOT employed by the organization sponsoring the study.
There IS an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Investigator has no publication right.
Results Point of Contact
Layout table for Results Point of Contact information
Name/Title: Albert Collinson
Organization: Theracos Sub, LLC
Phone: (508) 630-2129
EMail: acollinson@theracos.com
Layout table for additonal information
Responsible Party: Theracos
ClinicalTrials.gov Identifier: NCT02769481    
Other Study ID Numbers: THR-1442-C-480
First Submitted: May 3, 2016
First Posted: May 11, 2016
Results First Submitted: March 25, 2021
Results First Posted: May 27, 2021
Last Update Posted: May 27, 2021