An Efficacy and Safety Study of Fixed-dose Rosiglitazone/Glimepiride to Treat Chinese Type 2 Diabetes Patients

This study has been terminated.
(US FDA/EMA/SFDA decisions to rosiglitazone-containing medicines, ethic)
Sponsor:
Information provided by (Responsible Party):
GlaxoSmithKline
ClinicalTrials.gov Identifier:
NCT01453049
First received: October 13, 2011
Last updated: March 22, 2012
Last verified: December 2011
  Purpose

The purpose of this study is to demonstrate that the rosiglitazone/glimepiride fixed-dose combination tablet will safely and effectively control glycemia as first-line oral therapy in drug naïve subjects with type 2 diabetes. This 24-week study will compare the effects of treatment with rosiglitazone/glimepiride to treatment with glimepiride alone. The primary objective is to demonstrate superiority of rosiglitazone/glimepiride to glimepiride in lowering Glycosylated Hemoglobin (HbA1c).


Condition Intervention Phase
Diabetes Mellitus, Type 2
Drug: rosiglitazone/glimepiride fix dose combination
Drug: glimepiride
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Investigator)
Primary Purpose: Treatment
Official Title: A Multi-center, Randomized, Double-blind, Parallel-group Study to Compare the Efficacy and Safety of Fixed-dose Rosiglitazone/Glimepiride Combination Therapy With Glimepiride Monotherapy for 24 Weeks in Drug Naive Subjects With Type 2 Diabetes

Resource links provided by NLM:


Further study details as provided by GlaxoSmithKline:

Primary Outcome Measures:
  • Change From Baseline in Glycosylated Hemoglobin (HbA1c) at Week 24 [ Time Frame: Baseline (Week 0) and Week 24 ] [ Designated as safety issue: No ]
    Blood samples of participants were collected for HbA1c assessment. HbA1c is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over a 2- to 3-month period. The American Diabetes Association has recommended an HbA1c value below 53 millimoles per mole (mmol/mol) (7.0%) for most participants. Change from Baseline in HbA1c was calculated as the value at Week 24 minus the value at Baseline.


Secondary Outcome Measures:
  • Change From Baseline in Fasting Plasma Glucose (FPG) at Week 24 [ Time Frame: Baseline (Week 0) and Week 24 ] [ Designated as safety issue: No ]
    Blood samples of participants were collected for FPG assessment. The FPG test, also known as the fasting blood sugar test, measures blood sugar levels after the participant has not eaten (fasted) for 12 to 14 hours. Change from Baseline in FBG was calculated as the value at Week 24 minus the value at Baseline.

  • Number of HbA1c Responders and Non-responders [ Time Frame: Baseline (Week 0) and Week 24 (LOCF) ] [ Designated as safety issue: No ]
    Blood samples of participants were collected for HbA1c assessment. HbA1c responders were defined as participants who had achieved HbA1c <7%, or who achieved a decrease of >= 0.7% from Baseline at Week 24 (LOCF).

  • Number of FPG Responders and Non-responders [ Time Frame: Baseline (Week 0) and Week 24 (LOCF) ] [ Designated as safety issue: No ]
    Blood samples of participants were collected for FPG assessment. FPG responders are definded as participants who had a >=1.7 mmol/L decrease from Baseline FPG or who achieved a FPG level < 6.1 mmol/L at Week 24 (LOCF).

  • Number of Participants Who Achieved HbA1c <7%, HbA1c <=6.5%, or Who Achieved a Decrease of >=0.7% From Baseline [ Time Frame: Baseline (Week 0) and Week 24 (LOCF) ] [ Designated as safety issue: No ]
    Blood samples of participants were collected for HbA1c assessment.

  • Change From Baseline in Fasting Proinsulin and Insulin at Week 24/Early Withdrawal (EW) [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    Blood samples of participants who had fasted for 12-14 hours were collected for fasting proinsulin (precursor of insulin) and insulin assessment. Preproinsulin is sequentially processed via proinsulin, through intermediate proteolytic cleavage products, to insulin and C-peptide before release from the beta cell granule by exocytosis. Elevated levels of proinsulin are considered indicative of beta cell dysfunction. Insulin is a hormone that regulates carbohydrate and fat metabolism in the body. Change from Baseline was calculated as the value at Week 24/ EW minus the value at Baseline (Week 0).

  • Change From Baseline in Homeostasis Model Assessment Sensitivity (HOMA-S) at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    Blood samples of participants who had fasted for 12-14 hours were collected for fasting glucose (FG) and insulin (FI) assessment. The homeostatic model assessment (HOMA) is a method used to quantify insulin resistance (a condition in which natural hormone insulin becomes less effective in lowering blood sugars) and beta-cell (specialized cells in the pancreas producing insulin) function. HOMA-S is calculated using the following model to predict glucose and insulin concentrations=(FI[milliunits (mU)/milliliter (ml)]*FG [millimoles per liter (mmol/l)])/22.5. numerator, num.; denominator, denom.

  • Change From Baseline in Homeostasis Model Assessment Beta-cell Function (HOMA-B) at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    Blood samples of participants who had fasted for 12 to 14 hours were collected for fasting glucose (FG) and insulin (FI) assessment. The homeostatic model assessment (HOMA) is a method used to quantify insulin resistance (a condition in which natural hormone insulin becomes less effective in lowering blood sugars) and beta-cell (specialized cells in the pancreas producing insulin) function. HOMA-B is calculated using the following mathematical model to predict glucose and insulin concentrations=(20*FI[mU/ml])/(FG[mmol/l]-3.5).

  • Number of Participants at Various Dose Levels at Week 24/EW [ Time Frame: Week 24/EW ] [ Designated as safety issue: No ]
    The number of participants at the different dose levels at Week 24/EW was recorded. The different dose levels for Rosi + Glim are: Dose level 1, Rosi 4 mg + Glim 1 mg; Dose level 2, Rosi 4 mg + Glim 2 mg; Dose level 3, Rosi 4 mg + Glim 4 mg. The different dose levels for Glim are: Dose level 1, Glim 1 mg; Dose level 2, Glim 2 mg; Dose level 3, Glim 4 mg.

  • Change From Baseline in Total Cholesterol (TC), High Density Lipoprotein-cholesterol (HDL-C), Low Density Lipoprotein-cholesterol (LDL-C), and Triglyceride (TG) at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    Blood samples of participants who had fasted for 12 to 14 hours were collected for lipid profile (TC, HDL-C, LDL-C, TG) assessment. The lipid profile asesses the risk of heart disease. Change from Baseline in TC, HDL-C, LDL-C, and TG was calculated as the value at Week 24)/EW minus the value at Baseline.

  • Change From Baseline in Blood Urea Nitrogen (BUN), Sodium, Potassium, Chloride, Calcium, and Phosphorus at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    Blood samples of participants were collected for BUN and electrolyte (sodium, potassium, chloride, calcium, and phosphorus) assessment. The electrolyte balance asseses the condition of the heart and the kidneys, and BUN assesses the condition of the kidneys. Change from Baseline in BUN, sodium, potassium, chloride, calcium, and phosphorus was calculated as the value at Week 24/EW minus the value at Baseline.

  • Change From Baseline in the Ratio of TC/HDL-C and LDL-C/HDL-C at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    Blood samples of participants who had fasted for 12 to 14 hours were collected for lipid profile (TC, HDL-C and LDL-C) assessment. The ratio of TC/HDL-C and LDL-C/HDL-C was calculated. Change from Baseline in the ratio of TC/HDL-C and LDL-C/HDL-C was calculated as the value at Week 24/EW minus the value at Baseline. For TC/HDL-C, the numerator is TC, and the denominator is HDL-C. For LDL-C/HDL-C, the numerator is LDL-C, and the denominator is HDL-C.

  • Change From Baseline in High Sensitivity C-reactive Protein (Hs-CRP) at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    Blood samples of participants were collected for hs-CRP assessment. CRP is a marker of inflammation. High levels of CRP predict the risk of heart disease and diabetes. Change from Baseline in hs-CRP was calculated as the value at Week 24/EW minus the value at Baseline.

  • Percent Change From Baseline in High Sensitivity C-reactive Protein (Hs-CRP) at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    Blood samples of participants were collected for hs-CRP assessment. CRP is a marker of inflammation. High levels of CRP predict the risk of heart disease and diabetes. Percent change from Baseline in hs-CRP was calculated as the value at Visit 8 (Wk 24)/ EW minus the value at Baseline divided by value at Wk 24/ EW multiplied by 100.

  • Change From Baseline in European Quality of Life-5 Dimensions (EQ-5D) at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    EQ-5D is used as a measure of health outcome and includes single-item measures (coded on a 3-point scale [1, no problems; 2, some problems; 3, severe problems]) of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The instrument includes a global rating of current health using a visual analog scale (VAS): 0 (worst imaginable) to 100 (best imaginable). Health states may be converted to a single summary index by applying a formula that attaches values to each of the levels in each dimension. The index scale is -0.111 to 1. A lower index indicates worse health.

  • Change From Baseline in Adjusted Diabetes Quality of Life (A-DQOL) Scores at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    In diabetic participants, QOL, anxiety, and depression were measured by the A-DQOL scale . There are 46 core items (10 additional items for adolescents) and 4 major dimensions: treatment satisfaction, treatment impact, worry about long-term complications, and worry about social/vocational issues. Participants respond to all items on a 5-point Likert scale: 1, no impact, no worries, or always satisfied; 5, always affected, always worried, or never satisfied. The total score is a sum of the individual scores of all 46 items (range of 46 to 230); a lower score indicates a better QOL.

  • Number of Participants With Hypoglycemic Events [ Time Frame: Week 24/EW ] [ Designated as safety issue: No ]
    Blood samples of participants were collected for the assessment of blood glucose levels. Hypoglycemia is a condition that occurs when the blood glucose is below 70 mg/dL or 4 mmol/L. All participants; participants with HbA1c <7%, or who achieved a decrease of >= 0.7% from Baseline at Week 24 (HbA1c responders); and participants who had a >=1.7 mmol/L decrease from Baseline FPG or who achieved a FPG <6.1 mmol/L at Week 24 (FPG responders) were evaluated.

  • Number of Hypoglycemic Events [ Time Frame: Week 24/EW ] [ Designated as safety issue: No ]
    A hypoglycemic event is a condition that occurs when the blood glucose is below 70 mg/dL or 4 mmol/L. All participants, participants with HbA1c <7%, or who achieved a decrease of >= 0.7% from Baseline at Week 24 (HbA1c responders); and participants who had a >=1.7 mmol/L decrease from Baseline FPG or who achieved a FPG <6.1 mmol/L at Week 24 (FPG responders) were evaluated.

  • Number of Participants With a Bone Fracture [ Time Frame: Week 24/EW ] [ Designated as safety issue: No ]
    Participants with a break in the continuity (fracture) of the bone were evaluated.

  • Change From Baseline in White Blood Cell (WBC) Count and Platelet Count at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    Blood samples of participants were collected for WBC count and platelet count assessment. Change from Baseline in WBC count and platelet count was calculated as the value at Week 24/EW minus the value at Baseline.

  • Change From Baseline in Red Blood Cell (RBC) Count at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    Blood samples of participants were collected for RBC count assessment. Change from Baseline in RBC count was calculated as the value at Week 24/EW minus the value at Baseline.

  • Change From Baseline in Lymphocytes, Monocytes, Neutrophils, Eosinophils, and Basophils at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    Blood samples of participants were collected for lymphocyte, monocyte, neutrophil, eosinophil, and basophil assessment. Change from Baseline in lymphocytes, monocytes, neutrophils, eosinophils, and basophils was calculated as the value at Week 24/EW minus the value at Baseline.

  • Change From Baseline in Hematocrit (HCT) at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    Blood samples of participants were collected for HCT assessment. Change from Baseline in HCT was calculated as the value at Week 24/EW minus the value at Baseline. HCT is measured as the percentage of the volume of whole blood that is made up of red blood cells.

  • Change From Baseline in Hemoglobin (HE), Mean Corpuscular Hemoglobin Concentration (MCHC), Total Protein (TP), and Albumin at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    Blood samples of participants were collected for HE, MCHC, and TP assessment. Change from Baseline in HE, MCHC, and TP was calculated as the value at Week 24/EW minus the value at Baseline.

  • Change From Baseline in Mean Corpuscular Volume (MCV) at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    Blood samples of participants were collected for MCV assessment. Change from Baseline in MCV was calculated as the value at Week 24/EW minus the value at Baseline. MCV is the average size of the red blood cells expressed in femtoliters. MCV is calculated by dividing the hematocrit (as percent) by the RBC count in millions per microliter of blood, then multiplying by 10. MCV is one of the three main RBC indices that are helpful in determining the cause of anemia.

  • Change From Baseline in Mean Corpuscular Hemoglobin (MCH) at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    Blood samples of participants were collected for MCH assessment. Change from Baseline in MCH was calculated as the value at Week 24/EW minus the value at Baseline. MCH is the average amount of hemoblobin inside a RBC expressed in picograms. MCH is calculated by dividing the hemoglobin concentration in grams per deciliter by the RBC count in millions per microliter, then multiplying by 10. MCH is one of the three main RBC indices which are helpful to determine the cause of anemia.

  • Change From Baseline in Alanine Transaminase (ALT), Aspartate Aminotransferase (AST), Gamma-glutamyl Transpeptidase (GGT), Lactate Dehydrogenase (LDH), Alkaline Phosphatase (ALP), and Creatine Kinase (CK) at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    Blood samples of participants were collected for ALT, AST, GGT, LDH, ALP, and CK assessment. Change from Baseline in ALT, AST, GGT, LDH, ALP, and CK was calculated as the value at Week 24/EW minus the value at Baseline.

  • Change From Baseline in Total Bilirubin (TB), Direct Bilirubin (DB), Creatinine, and Uric Acid (UC) at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    Blood samples of participants were collected for TB, DB, creatinine, and UC assessment. Change from Baseline in TB, DB, creatinine, and UC was calculated as the value at Week 24/EW minus the value at Baseline.

  • Change From Baseline in Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    The blood pressure of the participants was measured. Change from Baseline in SBP and DBP was calculated as the value at Weeks 24/EW minus the value at Baseline.

  • Change From Baseline in Heart Rate at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    The heart rate of the participants was measured. Change from Baseline in heart rate was calculated as the value at Week 24/EW minus the value at Baseline.

  • Change From Baseline in Weight at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    The weight of the participants was measured. Change from Baseline in weight was calculated as the value at Week 24/EW minus the value at Baseline.

  • Change From Baseline in Electrocardiogram (ECG) Assessment of Heart Rate at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    Electrocardiograms of the participants were taken for the evaluation of heart rate. Change from Baseline in heart rate was calculated as the value at Week 24/EW minus the value at Baseline.

  • Change From Baseline in Electrocardiogram (ECG) Data at Week 24/EW [ Time Frame: Baseline (Week 0) and Week 24/EW ] [ Designated as safety issue: No ]
    PR, QT, QTc, RR, QRS, and QRS axis data were measured by ECG. The PR interval (int.) starts at the beginning of the atrial contraction and ends at the beginning of the ventricular contraction. QT (QT int.) and QTc (corrected QT int.) indicate how fast the ventricles are repolarized, becoming ready for a new cycle. The RR int. represents the duration of the ventricular cardiac cycle and is an indicator of ventricular rate. QRS (QRS duration) indicates how fast the ventricles depolarize. The QRS axis is an indicator of the electrical heart axis, which is an average of all heart depolarization.


Enrollment: 86
Study Start Date: April 2010
Study Completion Date: October 2010
Primary Completion Date: October 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: fix dose of rosiglitazone/glimepiride
4mg/1mg, 4mg/2mg, 4mg/4mg
Drug: rosiglitazone/glimepiride fix dose combination
oral, once daily, dosage is titrated according to FPG and hypoglycemia events
Other Name: Avandaryl
Active Comparator: glimepiride
1mg, 2mg, 4mg
Drug: glimepiride
oral, once daily, dosage is titrated according to FPG and hypoglycemia
Other Name: Amaryl

Detailed Description:

The antihyperglycemic effect of the thiazolidinedione (TZD) class of oral antidiabetic agents is due to their ability to increase insulin sensitivity at the cellular level, which in turn improves the ability of endogenous insulin to regulate glucose utilization by the tissues. Compounds of the sulfonylurea (SU) class act to stimulate insulin production by the pancreas, overcoming insulin resistance by increasing circulating insulin levels. The mechanisms of two kind OADs may be viewed as complementary, offering the opportunity for improved efficacy and durability of effect through coadministration of a TZD and a sulfonylurea.

Successful management of type 2 diabetes mellitus (T2DM) requires aggressive glycemic control starting at the earliest stages of the disease. Rosiglitazone/glimepiride combination therapy, with complementary mechanisms of action, has the potential to provide significant benefits over monotherapy as first line therapy. Treatment with rosiglitazone/glimepiride at this early stage of diabetes is expected to provide better glycemic control and allow a greater proportion of patients to achieve target glycemic goals than oral monotherapy.

This was a multicenter, randomized, double-blinded, parallel, study to compare the effects of treatment with rosiglitazone/glimepiride combination or glimepiride in drug naïve T2 DM patients.

  Eligibility

Ages Eligible for Study:   18 Years to 75 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • type 2 diabetes mellitus
  • HbA1c between 7.5% and 11.0% at screening
  • FPG between 7.0mmol/L and 13.3mmol/L at screening and at randomization visit
  • subject was treated with diet and/or exercise alone
  • QTc<450mesc or QTc<480msec for patients with bundle branch block
  • Body Mass Index (BMI) >19kg/m2
  • Subject has given written informed consent

Exclusion Criteria:

  • Documented history of significant hypersensitivity to thiazolidinediones, sulfonylureas, or compounds with similar chemical structures
  • Ongoing edema or history of edema requiring pharmacological treatment in the 12 months prior to screening
  • Presence of ischemic heart disease and/or peripheral arterial disease, or NYHA grade I-IV congestive heart failure
  • Taking nitrates
  • Clinically significant renal or hepatic disease
  • Anemia
  • Severe hypertriglyceridemia (TG>=5.65mmol/L)
  • Use of oral corticosteroids and Nicotinic acid
  • Systolic blood pressure <170mmHg, or diastolic blood pressure > 100mmHg while on anti-hypertensive treatment
  • Hyperthyroidism requiring treatment
  • Diagnosed macular edema
  • Women who are lactating, pregnant, or planning to become pregnant
  • Presence of an active cancer or recently treated for cancer
  • Drug/alcohol abuse
  • Unwilling or unable to comply with the procedures described in the protocol
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01453049

Locations
China, Hubei
GSK Investigational Site
Wuhan, Hubei, China, 430030
China, Jiangsu
GSK Investigational Site
Suzhou, Jiangsu, China, 215004
China, Liaoning
GSK Investigational Site
Dalian, Liaoning, China, 116027
China, Zhejiang
GSK Investigational Site
Hangzhou, Zhejiang, China, 310009
GSK Investigational Site
Hangzhou, Zhejiang, China, 310003
China
GSK Investigational Site
Beijing, China, 100730
GSK Investigational Site
Beijing, China, 100029
GSK Investigational Site
Chongqing, China, 400016
GSK Investigational Site
Shanghai, China, 200080
GSK Investigational Site
Shenyang, China, 110003
GSK Investigational Site
Tianjin, China, 300052
GSK Investigational Site
Wuhan, China, 430022
Sponsors and Collaborators
GlaxoSmithKline
Investigators
Study Director: GSK Clinical Trials GlaxoSmithKline
  More Information

No publications provided

Responsible Party: GlaxoSmithKline
ClinicalTrials.gov Identifier: NCT01453049     History of Changes
Other Study ID Numbers: 113263
Study First Received: October 13, 2011
Results First Received: October 27, 2011
Last Updated: March 22, 2012
Health Authority: China: Food and Drug Administration
United States: Food and Drug Administration

Keywords provided by GlaxoSmithKline:
rosiglitazone/glimepiride, fix dose, type 2 diabetes

Additional relevant MeSH terms:
Diabetes Mellitus, Type 2
Diabetes Mellitus
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Glimepiride
Rosiglitazone
Anti-Arrhythmia Agents
Cardiovascular Agents
Therapeutic Uses
Pharmacologic Actions
Hypoglycemic Agents
Physiological Effects of Drugs
Immunosuppressive Agents
Immunologic Factors

ClinicalTrials.gov processed this record on September 16, 2014