Diabetes and Hypertension
April 27, 2015
Ultragenyx Pharmaceutical released
results of an investigator-sponsored trial of
triheptanoin (UX007) for the treatment of
movement disorders associated with glucose
transporter type-1 deficiency syndrome (Glut1
DS). The open-label, investigator-sponsored
trial enrolled eight Glut1 DS patients between
seven and 47 years old with non-epileptic
paroxysmal manifestations, a neurological
symptom characterized by sudden, transient,
involuntary movements. Patients completed
comprehensive diaries to record all motor
and non-motor events as well as a clinical
global impression scale during a baseline,
treatment, and withdrawal phase, each lasting
two months. Six patients completed the
study. During the baseline phase without
triheptanoin, patients experienced on average
31 paroxysmal manifestations, including 16
dystonic events. During the triheptanoin treatment
phase, patients reported a statistically
significant 90% reduction in these events to
an average of three paroxysmal manifestations,
including two dystonic events (p=0.028).
In the withdrawal phase, when triheptanoin
treatment was discontinued, the rate of paroxysmal
manifestations increased substantially
to an average of 24 events per patient,
including 12 dystonic events (p=0.043). In
addition, patients reported an improvement
in the clinical global impression scale during
the treatment phase with triheptanoin and a
worsening after withdrawal. This improvement
also was associated with a normalization of
induction of brain energy metabolism during
visual stimulation in patients receiving triheptanoin
as measured by 31P-NMR spectroscopy
(p=0.021). Triheptanoin was well-tolerated
in all patients. Two patients were considered
not compliant for reasons unrelated to safety
or tolerability. Ultragenyx intends to initiate
a confirmatory randomized double-blind
placebo-controlled study of triheptanoin in
the Glut1 DS movement disorder phenotype
and anticipates discussions with the FDA on
final study design details in the second half of
May 27, 2013
Rhythm released results from a phase Ib trial of RM-131 for diabetic gastroparesis in type 1 diabetes. This randomized, double-blind, placebo-controlled, single-dose, two-period crossover study enrolled 10 patients with type 1 diabetes, a history and symptoms of diabetic gastroparesis and documentation of delayed gastric emptying. Subjects received a single dose of RM-131 100mcg. Results showed RM-131 significantly accelerates early gastric emptying and reduces upper gastrointestinal (GI) symptoms in type 1 diabetic patients. The median gastric emptying half-time was reduced by ~55%. RM-131 was generally well tolerated, with no serious adverse events. The FDA has granted Fast Track review status to RM-131 for the treatment of diabetic gastroparesis.
October 8, 2012
Boehringer Ingelheim and Eli Lilly released pooled analysis of two phase IIb trials of empagliflozin in conjunction with metaformin for the treatment of type 2 diabetes (T2D). These randomized, double blind, placebo-controlled studies enrolled 903 patients. Subjects received 10mg or 25mg of empagliflozin plus metaformin, or placebo for 12 weeks. Results showed both dosages reduced the systolic blood pressure (SBP) and were statistically significant compared to placebo. SBP was reduced by 3.8mmHg and 4.5mmHg in the empagliflozin 10mg and 25mg arms, respectively, versus 1.2mmHg for placebo. Mean SBP at baseline of 131.3mmHg and 132.5mmHg were observed with empagliflozin 10mg and 25mg, respectively, versus 134.3mmHg with placebo. In patients with higher SBP at baseline (>140 mmHg), mean reductions of 17.0mmHg and 13.4mmHg were observed with empagliflozin 10mg and 25mg, respectively, and 10.4mmHg with placebo. The drug was well tolerated. The most frequent adverse events were urinary tract infection and genital infections. Empagliflozen is being investigated in 12 different ongoing multinational studies, with filing planned in the U.S. and Europe in 2013.
Merck issued results for a phase IIb trial of MK-3102 for the treatment of type 2 diabetes. This multi-center, randomized, double blind, placebo-controlled, dose-ranging study enrolled 685 patients with a mean baseline HbA1c of approximately 8%. Subjects received MK-3102 0.25mg, 1mg, 3mg, 10mg or 25mg once-weekly, or placebo, for 12 weeks. Results demonstrated MK-3102 significantly reduced HbA1c compared to placebo (p<0.001) from baseline across all doses. The placebo-adjusted reduction from baseline in HbA1c was 0.71% with MK-3102 25mg; 0.67% with 10mg; 0.49% with 3mg; 0.50% with 1mg; and 0.28% with 0.25mg. The drug was well tolerated. Based on these data, Merck is initiating a phase III study.
August 13, 2012
TWi Biotechnology reported results from a phase II trial of AC-201 for the treatment of type 2 diabetes (T2D). This multinational, dose-ranging study enrolled 259 patients whose T2D was uncontrollable on up to three oral medications. Subjects received AC-201 25mg, 50mg, 75mg or placebo twice daily for 24 weeks. In the intent-to-treat population, AC-201 showed placebo-corrected reductions in HbA1c of 0.20%, 0.29%, and 0.35% (p<0.05), respectively. In the perprotocol population, the placebo-corrected reduction in HbA1c was 0.37%, 0.42%, and 0.49%, respectively. AC-201 was well tolerated up to 75mg. The most frequent adverse event was diarrhea. TWi Biotechnology did not note its plans for AC-201.
July 16, 2012
GlaxoSmithKline issued results from a phase III trial of albiglutide versus sitagliptin for the treatment of renal impairment. This double-blind, active-controlled, parallel-group, multicenter study, Harmony 8, enrolled patients with type 2 diabetes. Subjects received recommended doses of either albiglutide of sitagliptin for 52 weeks. At the 26-week primary endpoint, albiglutide showed clinically and statistically significant reductions in HbA1c from baseline (8.08% for albiglutide and 8.22% for sitagliptin) and superiority versus sitagliptin (reduction of 0.83% vs 0.52%; p<0.0001 for non-inferiority and p=0.0003 for superiority). At the primary endpoint, weight loss was significantly greater in the albiglutide group than the sitagliptin group (-0.79kg vs -0.19kg; p=0.0281). During the full 52-week treatment period, albiglutide was generally well tolerated. The most frequent adverse events were diarrhea (albiglutide 10%, sitagliptin 6.5%), nausea (4.8%, 3.3%) and vomiting (1.6%, 1.2%). With these data now available, GSK intends to commence global regulatory submissions for its investigational glucagon-like peptide-1 (GLP-1) receptor agonist albiglutide for the treatment of type 2 diabetes in early 2013.
July 2, 2012
Lexicon Pharmaceuticals reported results from a phase IIb trial of LX4221 for the treatment of type 2 diabetes. The multi-center, randomized, dose-ranging study enrolled 299 patients who were concurrently being treated with metformin. Subjects received LX4221 75mg once daily (QD), 200mg QD, 200mg twice daily (BID) or 400mg QD, or placebo for 12 weeks. Top-line results showed that patients in the LX4211 treatment arms had mean HbA1C reductions from baseline of 0.43%, 0.52%, 0.79% and 0.95%, respectively (p<0.001 for all treatment arms). In patients randomized to placebo, HbA1C decreased by 0.09%. LX4211 treatment also produced significant reductions in body weight and blood pressure. The drug was well-tolerated and safe. Adverse events were similar to placebo. Based on these data, Lexicon plans to initiate a phase III trial of LX4221 in the first half of 2013.
June 18, 2012
Bristol-Myers Squibb and AstraZeneca reported results from a phase III trial of dapagliflozin for the treatment of type 2 diabetes. This multicenter, randomized, double-blind, placebo-controlled, parallel group study enrolled 447 adult patients with inadequate glycemic control who were on a stable dose of sitagliptin. Subjects in stratum one received dapagliflozin 10mg or placebo added to sitagliptin 100mg/d. Patients in stratum two received dapagliflozin 10mg or placebo added to sitagliptin 100mg/d plus metformin ≥1500mg/d. Both stratums were conducted for 24 weeks, plus a 24-week blinded extension. Subjects (n≡223) receiving dapagliflozin 10mg plus sitagliptin with or without metformin demonstrated significantly greater improvements in glycemic control at 24 weeks compared to subjects (n≡224) receiving placebo plus sitagliptin with or without metformin, with a change in baseline in HbA1c of -0.48% (p-value <0.0001, Last Observation Carried Forward [LOCF]). Significant reductions in body weight were observed with dapagliflozin compared to placebo in the entire treatment cohort (-1.89kg, LOCF), stratum one (-1.85kg, LOCF) and stratum two (-1.87kg, LOCF), and were sustained out to 48 weeks. The drug was well tolerated. The most common adverse events were nasopharyngitis, back pain, urinary tract infection, pharyngitis, arthralgia and headache. BMS and AstraZeneca are currently waiting for the European Commission to review dapagliflozin.
August 20, 2007
Oramed issued positive results from a phase Ia trial of their oral insulin gel capsule for the treatment of diabetes. This single blind, open-label trial enrolled a small group of healthy subjects in Israel. Subjects received several different dosing regimens and examined for changes in insulin, glucose and C-peptide plasma concentrations over time. With the exception of the anticipated insulin related hypoglycemic side effects, no significant adverse effects were noted after administration of the insulin gel capsule. Based on the good safety profile and positive pharmacokinetic and pharmacologic outcomes, Oramed plans to initiate additional phase I trials later in 2007.
August 22, 2005
Cardiome Pharma announced negative results of a phase II trial, dubbed "OPT-CHF," of oxypurinol for the treatment of congestive heart failure (CHF). Trial data failed to meet the primary composite endpoint relative to placebo (p= 0.357); this endpoint included improvement in NYHA functional class, rate of hospitalization or emergency intervention for worsening CHF, need for additional interventional treatment, withdrawal of drug treatment due to refractory disease and cardiovascular death. Trial data also failed to demonstrate drug efficacy in secondary endpoints, including Minnesota CHF Quality of Life assessment and time to acute clinical events. This randomized, double-blind, placebo-controlled study enrolled 405 CHF patients across 53 sites in the US and Canada, who received 600 mg oral oxypurinol or placebo daily for 24 weeks.