Alogliptin plus voglibose in Japanese patients with type 2 diabetes: a randomized, double-blind, placebo-controlled trial with an open-label, long-term extension

Abstract

Objective:

To compare the efficacy and safety of alogliptin and placebo as add-on therapy in Japanese patients with type 2 diabetes who experienced inadequate glycemic control on voglibose plus diet/exercise therapy.

Research design and methods:

During an 8 week screening phase, patients aged ≥20 years were stabilized on voglibose 0.2 mg three times daily plus diet/exercise therapy. Those with HbA1c between ≥6.9% and <10.4% were randomly assigned to 12 weeks’ double-blind treatment with once daily alogliptin 12.5 or 25 mg, or placebo. The primary endpoint was the change in HbA1c at 12 weeks from baseline. Patients then entered an open-label, 40 week extension trial (patients in the placebo group were randomly allocated to alogliptin 12.5 or 25 mg).

Clinical trials registration:

www.clinicaltrials.gov; pivotal trial NCT01263483; Long term trial NCT01263509.

Results:

Least square mean change in HbA1c after 12 weeks’ therapy from baseline (primary endpoint) was significantly greater in the alogliptin 12.5 mg (−0.96%; P < 0.0001) and 25 mg (−0.93%; P < 0.0001) groups compared with placebo (+0.06%). This was associated with statistically significant improvements in other measures of glycemic control, in particular sustained reductions in fasting plasma glucose and postprandial plasma glucose. These benefits were maintained for the duration of the 1 year study and, importantly, they were achieved without detrimental effects on tolerability/safety. In particular, there was no increase in the rate of hypoglycemia and almost no changes in mean body weight.

Conclusions:

Addition of once daily alogliptin to voglibose monotherapy in Japanese patients with uncontrolled type 2 diabetes produced clinically significant improvements in glycemic control, and was well tolerated.

Key words::

• Alogliptin
• α-glucosidase inhibitor
• Antihtperglycemic therapy
• DPP-4 inhibitor
• Type 2 diabetes
• Voglibose

Transparency

Declaration of funding

The study was funded by Takeda Pharmaceutical Company, Osaka, Japan.

Declaration of financial/other relationships

T.F., M.H. and S.H. are employees of Takeda Pharmaceutical Company, Osaka, Japan. K.K. has prepared manuscripts and/or acted as a consultant for Astellas, Astra Zeneca, Banyu, Daiichi-Sankyo, Dainippon-Sumitomo, Novartis, Novo Nordisk, Sanofi Aventis and Takeda. Y.S. has acted as a consultant to Eli Lilly, GlaxoSmithKline, Novo Nordisk, Otsuka, Sanofi Aventis, Taisho and Takeda.

Y.S. and K.K. were the medical advisors for the study. T.F. and S.H. were responsible for the day-to-day running of the study including data collection and synthesis. Y.S. prepared the first draft of the manuscript and all authors reviewed/edited the manuscript and agreed with the final version of the article having full access to all information.

Acknowledgments

The authors wish to thank all investigators involved in this study (see appendix), since without their dedicated support this trial would not have been possible. English language interpretation was kindly provided by Dr Steve Clissold (ContentEdNet, Madrid, Spain) and was funded by Takeda Pharmaceutical Company, Osaka, Japan.