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Safety and Efficacy of Exenatide Once Weekly Injection Versus Metformin, Dipeptidyl Peptidase-4 Inhibitor, or Thiazolidinedione as Monotherapy in Drug-Naive Patients With Type 2 Diabetes (DURATION-4)

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: NCT00676338
Recruitment Status : Completed
First Posted : May 13, 2008
Results First Posted : November 26, 2012
Last Update Posted : April 9, 2015
Sponsor:
Collaborator:
Eli Lilly and Company
Information provided by (Responsible Party):
AstraZeneca

Study Description
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Brief Summary:
This study will compare the effects of 2.0 mg exenatide once weekly injection as monotherapy to 3 active comparators(metformin, dipeptidyl peptidase-4 inhibitor, and thiazolidinedione) in drug naive patients with type 2 diabetes treated with diet and exercise.

Condition or disease Intervention/treatment Phase
Type 2 Diabetes Mellitus Drug: exenatide once weekly Drug: metformin Drug: sitagliptin Drug: pioglitazone Phase 3

Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 820 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: Safety and Efficacy of Exenatide Once Weekly Injection Versus Metformin, Dipeptidyl Peptidase-4 Inhibitor, or Thiazolidinedione as Monotherapy in Drug-Naive Patients With Type 2 Diabetes
Study Start Date : November 2008
Actual Primary Completion Date : July 2010
Actual Study Completion Date : January 2011

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
Experimental: Exenatide Once Weekly Drug: exenatide once weekly
subcutaneous injection, 2mg, once weekly plus placebo oral once daily
Active Comparator: Metformin Drug: metformin
oral, 1000-2500mg, daily plus placebo once weekly subcutaneous injection
Active Comparator: Sitagliptin Drug: sitagliptin
oral, 100 mg, daily plus placebo once weekly subcutaneous injection
Active Comparator: Pioglitazone Drug: pioglitazone
oral, 30-45mg, daily plus placebo once weekly subcutaneous injection


Outcome Measures
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Primary Outcome Measures :
  1. Change in HbA1c From Baseline to Week 26 [ Time Frame: Baseline, Week 26 ]
    Change in HbA1c from baseline to Week 26.

  2. Percentage of Patients Achieving HbA1c <=7% at Week 26 [ Time Frame: Baseline, Week 26 ]
    Percentage of patients achieving HbA1c <=7% at Week 26 (for patients with baseline HbA1c >7%).


Secondary Outcome Measures :
  1. Change in Fasting Serum Glucose (FSG) From Baseline to Week 26 [ Time Frame: Baseline, Week 26 ]
    Change in FSG from baseline to Week 26.

  2. Change in Body Weight From Baseline to Week 26 [ Time Frame: Baseline, Week 26 ]
    Change in Body Weight from baseline to Week 26.

  3. Change in Fasting Total Cholesterol (TC) From Baseline to Week 26 [ Time Frame: Baseline, Week 26 ]
    Change in Fasting TC from baseline to Week 26.

  4. Change in Fasting High-Density Lipoprotein (HDL) From Baseline to Week 26 [ Time Frame: Baseline, Week 26 ]
    Change in Fasting HDL from baseline to Week 26.

  5. Ratio of Fasting Triglycerides at Week 26 to Baseline [ Time Frame: Baseline, Week 26 ]
    Ratio of Fasting Triglycerides (measured in mmol/L) at Week 26 to baseline. Log(Post-baseline Triglycerides) - log(Baseline Triglycerides); change from baseline to Week 26 is presented as ratio of endpoint to baseline.

  6. Assessment on Event Rate of Treatment-emergent Major Hypoglycemic Events [ Time Frame: Baseline to Week 26 ]
    Major hypoglycemia is defined as any event that has symptoms consistent with hypoglycemia resulting in loss of consciousness or seizure that shows prompt recovery in response to administration of glucagon or glucose, or documented hypoglycemia (blood glucose <3.0 mmol/L [54 mg/dL]) requiring the assistance of another person because of severe impairment in consciousness or behavior (whether or not symptoms of hypoglycemia are detected by the patient). Mean event rate = total number of events for all subjects in a treatment regimen / the total number of subject years of exposure for all subjects in that treatment. Standard error = square root of (total number of events / (subject years of exposure)**2).

  7. Assessment on Event Rate of Treatment-Emergent Minor Hypoglycemic Events [ Time Frame: Baseline to Week 26 ]
    Minor hypoglycemia is defined as a sign or symptom associated with hypoglycemia that is either self-treated by the patient or resolves on its own AND has a concurrent finger stick blood glucose <3.0 mmol/L (54 mg/dL) and not classified as major hypoglycemia. Mean event rate = total number of events for all subjects in a treatment regimen / the total number of subject years of exposure for all subjects in that treatment. Standard error = square root of (total number of events / (subject years of exposure)**2).

  8. Change in Systolic Blood Pressure From Baseline to Week 26. [ Time Frame: Baseline, Week 26 ]
    Change in Systolic Blood Pressure from baseline to Week 26.

  9. Change in Diastolic Blood Pressure From Baseline to Week 26. [ Time Frame: Baseline, Week 26 ]
    Change in Diastolic Blood Pressure from baseline to Week 26.


Eligibility Criteria
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Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • have type 2 diabetes and are treated with diet and exercise alone.
  • at least 18 years of age.
  • HbA1c between 7.1% and 11.0%, inclusive.
  • Body mass index (BMI) of 23 kg/m2 to 45 kg/m2, inclusive.
  • Have a history of stable body weight (not varying by >5% for at least 3 months prior to screening).

Exclusion Criteria:

  • Have history of cardiac disease or presence of active cardiac disease within the year prior to inclusion in the study including myocardial infarction, clinically significant arrhythmia, unstable angina, moderate to severe congestive heart failure, coronary artery bypass surgery, or angioplasty
  • Have a history of renal transplantation or are currently receiving renal dialysis
  • Have active or untreated malignancy, or have been in remission from clinically significant malignancy (other than basal cell or squamous cell skin cancer, in situ carcinomas of the cervix, or in situ prostate cancer) for less than 5 years.
  • Have history of severe GI disorder (e.g., gastroparesis)
  • Have a history of acute or chronic pancreatitis.
  • Have active proliferative retinopathy.
  • Have been treated with drugs that promote weight loss (e.g., Xenical®[orlistat], Meridia® [sibutramine], Acomplia® [rimonabant], Acutrim® [phenylpropanolamine], or similar over-the-counter medications) within 3 months of screening.
  • Have been treated with any antidiabetic agent for more than 7 days within 3 months prior to screening.
  • Have had an organ transplant.
  • Have previously completed or discontinued study drug in this study, withdrawn from this study or any other study investigating exenatide once weekly.
  • Have received treatment within the last 30 days with a drug that has not received regulatory approval for any indication at the time of study entry.
  • Are currently enrolled in any other clinical study.
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00676338


Locations
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Sponsors and Collaborators
AstraZeneca
Eli Lilly and Company
Investigators
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Study Director: Chief Medical Officer, MD Eli Lilly and Company
More Information
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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: AstraZeneca
ClinicalTrials.gov Identifier: NCT00676338    
Other Study ID Numbers: H8O-MC-GWCH (DURATION - 4)
First Posted: May 13, 2008    Key Record Dates
Results First Posted: November 26, 2012
Last Update Posted: April 9, 2015
Last Verified: March 2015
Keywords provided by AstraZeneca:
Amylin
Lilly
exenatide once weekly
Byetta
 Januvia
sitagliptin
thiazolidinedione
Additional relevant MeSH terms:
Layout table for MeSH terms
Diabetes Mellitus
Diabetes Mellitus, Type 2
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Metformin
Pioglitazone
Sitagliptin Phosphate
Exenatide
Hypoglycemic Agents
 Physiological Effects of Drugs
Incretins
Hormones
Hormones, Hormone Substitutes, and Hormone Antagonists
Dipeptidyl-Peptidase IV Inhibitors
Protease Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Anti-Obesity Agents