Effects of Metformin Hydrochloride (HCl) in Combination With Colesevelam HCl, Compared to Metformin HCl Alone, in Patients With Type 2 Diabetes Mellitus and the Effects of Colesevelam HCl on Lipids and Glucose on Pre-diabetic Patients. - Full Text View

Sponsor:	Daiichi Sankyo Inc.
Information provided by:	Daiichi Sankyo Inc.
ClinicalTrials.gov Identifier:	NCT00570739

Purpose

This is a 16-week double-blind, placebo-controlled (for colesevelam hydrochloride (HCl)) study in the type 2 diabetic subjects and pre-diabetic subjects. Diabetic participants will also be treated with open label, background,metformin HCl. Two-hundred sixty subjects with type 2 diabetes (T2DM) and 200 pre-diabetic subjects are planned to be be enrolled. Qualified subjects with T2DM will be randomized 1:1 to receive metformin HCl plus colesevelam HCl or metformin HCl plus placebo matching colesevelam HCl. Qualified pre-diabetic subjects will be randomized 1:1 to receive colesevelam HCl or matching placebo.

Condition	Intervention	Phase
Type 2 Diabetes Mellitus Hypercholesterolemia Pre-diabetes	Drug: Metformin HCl and Colesevelam Placebo Drug: Metformin HCl tablets and Colesevelam tablets Drug: Colesevelam placebo Drug: Colesevelam	Phase III

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:	Effects of Metformin HCl in Combination With Colesevelam HCl, Compared to Metformin HCl Alone, as Initial Therapy in Drug naïve Subjects With Type 2 Diabetes Mellitus, and the Effects of Colesevelam HCl on the Lipid Profile in Subjects With Pre Diabetes

Resource links provided by NLM:

Genetics Home Reference related topics: 6q24-related transient neonatal diabetes mellitus hypercholesterolemia

MedlinePlus related topics: Cholesterol Diabetes Diabetes Medicines Diabetes Type 2 Pre-diabetes

Drug Information available for: Lipids Colesevelam GT31-104 Metformin Metformin hydrochloride

U.S. FDA Resources

Further study details as provided by Daiichi Sankyo Inc.:

Primary Outcome Measures:

Percent Change of Hemoglobin A1C (HbA1C) From Baseline to 16 Weeks When Given as Initial Therapy to Drug-naïve, Diabetic Subjects. [ Time Frame: Baseline to 16 weeks ] [ Designated as safety issue: No ]
Percent Change in Low Density Lipoprotein-Cholesterol (LDL-C) in Pre-Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Percent Change in Hemoglobin A1C (HbA1C) When Given to Drug-naïve, Diabetic Subjects From Baseline to 4, 8, 12 and 16 Weeks. [ Time Frame: Baseline to 4, 8, 12, and 16 weeks ] [ Designated as safety issue: No ]
Fasting Plasma Glucose When Given to Drug-naïve, Diabetic Subjects From Baseline to 4, 8, 12, and 16 Weeks [ Time Frame: Baseline to 4, 8, 12, and 16 weeks ] [ Designated as safety issue: No ]
Fasting Insulin When Given to Drug-naïve, Diabetic Subjects From Baseline to 4, 8, 12, and 16 Weeks [ Time Frame: Baseline to 4, 8, 12, and 16 weeks ] [ Designated as safety issue: No ]
Fasting C-Peptide Levels When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 weeks ] [ Designated as safety issue: No ]
30 Minute Post-Meal Glucose Levels When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 weeks ] [ Designated as safety issue: No ]
1 Hour Post-Meal Glucose Levels When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 weeks ] [ Designated as safety issue: No ]
2 Hour Post-Meal Glucose Levels to in Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 weeks ] [ Designated as safety issue: No ]
2 Hour Post-Meal Insulin Levels When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 weeks ] [ Designated as safety issue: No ]
2 Hour Post-Meal C-Peptide Levels When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 weeks ] [ Designated as safety issue: No ]
The Percent Change of Low Density Lipoprotein Cholesterol (LDL-C) When Given to Drug-naïve, Diabetic Subjects From Baseline to 8, and 16 Weeks [ Time Frame: Baseline to 8, and 16 weeks ] [ Designated as safety issue: No ]
Percent Change of Non-High Density Lipoprotein (Non-HDL) Levels When Given to Drug-naïve, Diabetic Subjects From Baseline to 8, and 16 Weeks [ Time Frame: Baseline to 8, and 16 weeks ] [ Designated as safety issue: No ]
Percent Change of High Density Lipoprotein Cholesterol(HDL-C) When Given to Drug-naïve, Diabetic Subjects From Baseline to 8, and 16 Weeks [ Time Frame: Baseline to 8, and 16 weeks ] [ Designated as safety issue: No ]
Percent Change of Total Cholesterol (TC) When Given to Drug-naïve, Diabetic Subjects From Baseline to 8, and 16 Weeks [ Time Frame: Baseline to 8, and 16 weeks ] [ Designated as safety issue: No ]
Percent Change of Triglycerides (TG)When Given to Drug-naïve, Diabetic Subjects From Baseline to 8, and 16 Weeks [ Time Frame: Baseline to 8, and 16 weeks ] [ Designated as safety issue: No ]
Percent Change of Apolipoprotein A-1 (Apo A-1) When Given to Drug-naïve, Diabetic Subjects From Baseline to 8, and 16 Weeks [ Time Frame: Baseline to 8, and 16 weeks ] [ Designated as safety issue: No ]
Percent Change of Apolipoprotein B (Apo B)When Given to Drug-naïve, Diabetic Subjects From Baseline to 8, and 16 Weeks [ Time Frame: Baseline to 8, and 16 weeks ] [ Designated as safety issue: No ]
Percent Change of Apolipoprotein C3 (Apo C3)When Given to Drug-naïve, Diabetic Subjects From Baseline to 8, and 16 Weeks [ Time Frame: Baseline to 8, and 16 weeks ] [ Designated as safety issue: No ]
Change in the Levels of Various Lipoprotein Particles When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 weeks ] [ Designated as safety issue: No ]
Change in the Size of Various Lipoprotein Particles When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
Change in the Calculated Total Triglycerides When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
Change in the Calculated Very Low Density Lipoprotein Triglycerides When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
These calculated values are reported as part of an NMR analysis. The calculations are done by LipoScience, Inc., and are proprietary.
Change in the Calculated High Density Lipoprotein Cholesterol When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
These calculated values are reported as part of an NMR analysis. The calculations are done by LipoScience, Inc., and are proprietary.
Percent of Subjects Achieving HbA1c Goal of <7.0% at Weeks 4, 8, 12, and 16 if Baseline HbA1c Was > or = to 7.0% When Given to Drug-naïve, Diabetics [ Time Frame: Baseline to 4, 8, 12, and 16 Weeks ] [ Designated as safety issue: No ]
Percent of Subject Achieving HbA1c Goal of <6.5% at Weeks 4, 8, 12, and 16 When Given to Drug-naïve, Diabetic Subjects [ Time Frame: Baseline to 4, 8, 12 and 16 weeks ] [ Designated as safety issue: No ]
Percent of Subjects Achieving Low Density Lipoprotein-Cholesterol of <100 mg/dL at Weeks 8, 16 When Given to Drug-naïve, Diabetic Subjects [ Time Frame: Baseline to Weeks 8, and 16 ] [ Designated as safety issue: No ]
Percent of Subjects Achieving Low Density Lipoprotein-Cholesterol Goal of <70 mg/dL at Weeks 8, 16 When Given as to Drug-naïve, Diabetics [ Time Frame: Baseline to Weeks 8, and 16 ] [ Designated as safety issue: No ]
Change in Body Weight When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
Change in Waist-to-Hip Ratio When Given to Drug-Naive Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
Change in Plasma Glucose Area Under the Curve (0 to 120 Minutes) From the Baseline Glucose Tolerance Test (GTT) to the 16 Week GTT [ Time Frame: Baseline vs. 16 Weeks ] [ Designated as safety issue: No ]
Percent Change of Various Calculated Lipid Parameters When Given as Initial Therapy to Drug-naïve, Diabetic From Baseline to 16 Weeks Subjects [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
These calculated values are reported as part of an NMR analysis. The calculations are done by LipoScience, Inc., and are proprietary.
Percent of Subjects Achieving 2-Hr. Post Meal Glucose Goal of <180 mg/dL When Given to Drug-naïve, Diabetic Subjects From Baseline to Week 16 [ Time Frame: Baseline to Week 16 ] [ Designated as safety issue: No ]
Percent of Subjects Achieving Hs-C-Reactive Protein Goal of <2.0 mg/L When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
Percent Change in Low Density Lipoprotein-Cholesterol in Pre-Diabetic Subjects From Baseline to 8, and 16 Weeks [ Time Frame: Baseline to 8, and 16 Weeks ] [ Designated as safety issue: No ]
Percent Change in Non-High Density Lipoprotein-Cholesterol in Pre-Diabetic Subjects From Baseline to 8, and 16 Weeks [ Time Frame: Baseline to 8, and 16 Weeks ] [ Designated as safety issue: No ]
Percent Change in High Density Lipoprotein-Cholesterol in Pre-Diabetic Subjects From Baseline to 8, and 16 Weeks [ Time Frame: Baseline to 8, and 16 Weeks ] [ Designated as safety issue: No ]
Percent Change in Total Cholesterol in Pre-Diabetic Subjects From Baseline to 8, and 16 Weeks [ Time Frame: Baseline to 8, and 16 Weeks ] [ Designated as safety issue: No ]
Percent Change in Apolipoprotein A-1 in Pre-Diabetic Subjects From Baseline to 8, and 16 Weeks [ Time Frame: Baseline to 8, and 16 Weeks ] [ Designated as safety issue: No ]
Percent Change in Apolipoprotein B in Pre-Diabetic Subjects From Baseline to 8, and 16 Weeks [ Time Frame: Baseline to 8, and 16 Weeks ] [ Designated as safety issue: No ]
Percent Change in Apolipoprotein CIII in Pre-Diabetic Subjects From Baseline to 8, and 16 Weeks [ Time Frame: Baseline to 8, and 16 Weeks ] [ Designated as safety issue: No ]
Percent Change in Triglycerides in Pre-Diabetic Subjects From Baseline to 8, and 16 Weeks [ Time Frame: Baseline to 8, and 16 Weeks ] [ Designated as safety issue: No ]
Percent Change in Hs-C-Reactive Protein in Pre-Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline 16 Weeks ] [ Designated as safety issue: No ]
Level of Various Lipoprotein Particles in Pre-Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
Particle Size of Various Lipoprotein Particles in Pre-Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
Change of Various Calculated Lipid Parameters in Pre-Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
These calculated values are reported as part of an NMR analysis. The calculations are done by LipoScience, Inc., and are proprietary.
Percent Change of HbA1c in Pre-Diabetic Subjects From Baseline to 4, 8, 12, and 16 Weeks [ Time Frame: Baseline to 4, 8, 12, and 16 Weeks ] [ Designated as safety issue: No ]
Percent Change of Fasting Plasma Glucose in Pre-Diabetic Subjects From Baseline to 4, 8, 12, and 16 Weeks [ Time Frame: Baseline to 4, 8, 12, and 16 weeks ] [ Designated as safety issue: No ]
Percent Change of Fasting Insulin in Pre-Diabetic Subjects From Baseline to 4, 8, 12, and 16 Weeks [ Time Frame: Baseline to 4, 8, 12, and 16 Weeks ] [ Designated as safety issue: No ]
Change of Fasting C-peptide Levels in Pre-Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
Change of Glucose Levels 30 Minutes Post Oral Glucose Tolerance Test in Pre-Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
Change of Glucose Levels 1 Hour Post Oral Glucose Tolerance Test in Pre-Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
Change of Glucose Levels 2 Hours Post Oral Glucose Tolerance Test in Pre-Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
Change of Insulin Levels 2 Hours Post Oral Glucose Tolerance Test in Pre-Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
Change of C-Peptide Levels 2 Hours Post Oral Glucose Tolerance Test in Pre-Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
Percent of Subjects Achieving Low Density Lipoprotein-Cholesterol of <100 mg/dL at Weeks 8, 16 in Pre-Diabetic Subjects [ Time Frame: Baseline to 8, and 16 Weeks ] [ Designated as safety issue: No ]
Percent of Subjects Achieving Low Density Lipoprotein-Cholesterol of <70 mg/dL at Weeks 8, 16 in Pre-Diabetic Subjects [ Time Frame: Baseline to 8, and 16 Weeks ] [ Designated as safety issue: No ]
Change in Body Weight in Pre-Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
Change in Waist-to-Hip Ratio in Pre-Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
Area Under the Curve for Plasma Glucose From 0 to 120 Minutes During the Oral Glucose Tolerance Tests in Pre-Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
Percent Achievement of <140 mg/dL Plasma Glucose 2 Hours Post the Oral Glucose Tolerance Test in Pre-Diabetic Subjects Whose Corresponding Baseline Value Was >or= to 140 mg/dL From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
Percent Achievement of <110 mg/dL Fasting Plasma Glucose in Pre-Diabetic Subjects Whose Corresponding Baseline Value Was > or = to 110 mg/dL From Baseline to 4, 8, 12, and 16 Weeks [ Time Frame: Baseline to 4, 8, 12, and 16 Weeks ] [ Designated as safety issue: No ]
Percent Achievement of <100 mg/dL Fasting Plasma Glucose in Pre-Diabetic Subjects Whose Corresponding Baseline Value Was > or = to 100 mg/dL From Baseline to 4, 8, 12 and 16 Weeks [ Time Frame: Baseline to 4, 8, 12 and 16 weeks ] [ Designated as safety issue: No ]
Percent Achievement of <140 mg/dL Plasma Glucose Post 2 Hour Glucose Tolerance Test and Fasting Plasma Glucose <110 mg/dL in Pre-Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
Percent Achievement of Hs-C-Reactive Protein <2.0 mg/L in Pre-Diabetic Subjects Whose Corresponding Baseline Value Was > or = to 2.0 mg/L From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]
Percent of Subjects Meeting Type 2 Diabetes Criteria (Fasting Plasma Glucose >or= to 126 mg/dL or Plasma Glucose >or= to 200 mg/dL Post 2 Hr Glucose Tolerance Test in Pre-Diabetic Subjects From Baseline to 16 Weeks [ Time Frame: Baseline to 16 Weeks ] [ Designated as safety issue: No ]

Enrollment:	502
Study Start Date:	November 2007
Study Completion Date:	May 2009
Primary Completion Date:	April 2009 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Placebo Comparator: Diabetic Participants: Metformin HCl+Placebo for Colesevelam Participants will receive either 850 mg or 1700 mg of metformin HCl, depending on tolerability + 6 placebo tablets matching colesevelam 625 mg. Study medication is to be administered once daily for 16 weeks.	Drug: Metformin HCl and Colesevelam Placebo One or two Metformin HCl tablets 850 mg (depending on tolerability) and 6 colesevelam 625 mg placebo tablets once daily for 16 weeks
Experimental: Diabetic participants: Metformin HCl + Colesevelam Participants will receive either 850 mg or 1700 mg of metformin HCl, depending on tolerability + 6 colesevelam tablets, 625 mg. Study medication is to be administered once daily for 16 weeks.	Drug: Metformin HCl tablets and Colesevelam tablets One or two Metformin HCl tablets 850 mg (depending on tolerability) and 6 colesevelam 625 mg tablets once daily for 16 weeks
Placebo Comparator: Pre-diabetic Participants: Colesevelam Placebo Participants will receive 6 placebo tablets matching colesevelam 625 mg. Study medication is to be administered once daily for 16 weeks.	Drug: Colesevelam placebo Six colesevelam 625 mg placebo tablets will be given once a day for 16 weeks
Experimental: Pre-diabetes Participants: Colesevelam Participants will receive 6 colesevelam tablets, 625 mg. Study medication is to be administered once daily for 16 weeks.	Drug: Colesevelam Six colesevelam 625 mg tablets will be given once a day for 16 weeks.

Eligibility

Ages Eligible for Study:	18 Years to 79 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Age 18 to 79 years, inclusive.
HbA1C in the range of greater than or equal to 6.5 percent to small than or equal to 10.0 percent, to be enrolled in the T2DM cohort.
2-hour post 75 g OGTT glucose levels in the range of:
- greater than or equal to 200 mg/dL to be enrolled in the T2DM cohort, or
- greater than or equal to 140 to 200 mg/dL to be enrolled in the pre-diabetes cohort.
FPG levels in the range of:
- greater than or equal to 126 mg/dL to be enrolled in the T2DM cohort, or
- greater than or equal to 110 to smaller than or equal to 125 mg/dL to be enrolled in the pre-diabetes cohort.
LDL-C levels greater than or equal to 100 mg/dL.
Drug-naïve, defined as having never received treatment for T2DM or not having received antidiabetic drug therapy during the 3 months prior to screening visit.
Previous diagnosis of:
- T2DM or prediabetes, to be enrolled in the respective cohorts, or
- CHD, CVD, and/or primary hypercholesterolemia + BMI greater than or equal to 25 mg/kg2 to be screened for T2DM or pre-diabetes.
Understanding of the study procedures and agreement to participate in the study by giving written informed consent at screening visit.
Women may be enrolled if all 3 of the following criteria (in addition to the above criteria)are met:
- They are not pregnant (women of childbearing potential must have a negative serum pregnancy test [serum beta human chorionic gonadotropin )] at screening visit);
- They are not breast-feeding; and
- They do not plan to become pregnant during the study.
In addition to all of the above criteria, women must also meet 1 of the following 3 criteria to be enrolled:
- They have been post-menopausal for at least 1 year; or
- They are of childbearing potential and will practice 1 of the following methods of birth control throughout the study: oral, injectable, or implantable hormonal contraceptives; intrauterine device; diaphragm plus spermicide; or female condom plus spermicide. Methods of contraception that are not acceptable are partner's use of condoms or partner's vasectomy.

Exclusion Criteria:

History of type 1 diabetes and/or history of acute or chronic metabolic acidosis, including diabetic ketoacidosis.
History of chronic (requiring daily for greater than 2 months) use of insulin therapy, except for the treatment of gestational diabetes.
Current or prior (within the past 3 months) treatment with an oral antidiabetic drug.
Current or prior (within the past 3 months) treatment with colesevelam HCl (WelChol), colestipol, colestimide, or cholestyramine.
History of dysphagia, swallowing disorders, or intestinal motility disorder.
Any serious disorder, including pulmonary, hepatic, gastrointestinal (including clinically significant malabsorption), uncontrolled endocrine/metabolic, hematologic/oncologic (within the last 5 years), neurologic, and psychiatric diseases, that would interfere with the conduct of the study or interpretation of the data.
Acute coronary syndrome (eg, myocardial infarction or unstable angina), coronary intervention (coronary artery bypass graft or percutaneous transluminal coronary angioplasty or similar procedure), congestive heart failure (requiring pharmacological treatment), or transient ischemic attack within 3 months of screening visit.
History of pancreatitis.
History of acquired immune deficiency syndrome or human immunodeficiency virus.
History of drug or alcohol abuse within the past 2 years.
Hospitalization for any cause within 14 days prior to screening visit.
History of an allergic or toxic response to colesevelam HCl or any of its components.
Known hypersensitivity to metformin HCl.
Serum TG greater than or equal to 500 mg/dL.
Body mass index (BMI) greater than 40 kg/m2 .

Responsible Party:	Michael Jones, Sr. Director, Medical Affairs, Daiichi Sankyo, Inc.
ClinicalTrials.gov Identifier:	NCT00570739 History of Changes
Other Study ID Numbers:	WEL-411, IND 68,466
Study First Received:	December 10, 2007
Results First Received:	April 6, 2010
Last Updated:	July 19, 2010
Health Authority:	United States: Food and Drug Administration