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Xu M, Sun K, Xu W, Wang C, Yan D, Li S, Cong L, Pi Y, Song W, Sun Q, Xiao R, Peng W, Wang J, Peng H, Zhang Y, Duan P, Zhang M, Liu J, Huang Q, Li X, Bao Y, Zeng T, Wang K, Qin L, Wu C, Deng C, Huang C, Yan S, Zhang W, Li M, Sun L, Wang Y, Li H, Wang G, Pang S, Zheng X, Wang H, Wang F, Su X, Ma Y, Zhang W, Li Z, Xie Z, Xu N, Ni L, Zhang L, Deng X, Pan T, Dong Q, Wu X, Shen X, Zhang X, Zou Q, Jiang C, Xi J, Ma J, Sun J, Yan L. Fotagliptin monotherapy with alogliptin as an active comparator in patients with uncontrolled type 2 diabetes mellitus: a randomized, multicenter, double-blind, placebo-controlled, phase 3 trial. BMC Med 2023; 21:388. [PMID: 37814306 PMCID: PMC10563289 DOI: 10.1186/s12916-023-03089-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Dipeptidyl peptidase-4 inhibitors (DPP-4i) have become firmly established in treatment algorithms and national guidelines for improving glycemic control in type 2 diabetes mellitus (T2DM).To report the findings from a multicenter, randomized, double-blind, placebo-controlled phase 3 clinical trial, which was designed to assess the efficacy and safety of a novel DPP-4 inhibitor fotagliptin in treatment-naive patients with T2DM. METHODS Patients with T2DM were randomized to receive fotagliptin (n = 230), alogliptin (n = 113) or placebo (n = 115) at a 2:1:1 ratio for 24 weeks of double-blind treatment period, followed by an open-label treatment period, making up a total of 52 weeks. The primary efficacy endpoint was to determine the superiority of fotagliptin over placebo in the change of HbA1c from baseline to Week 24. All serious or significant adverse events were recorded. RESULTS After 24 weeks, mean decreases in HbA1c from baseline were -0.70% for fotagliptin, -0.72% for alogliptin and -0.26% for placebo. Estimated mean treatment differences in HbA1c were -0.44% (95% confidence interval [CI]: -0.62% to -0.27%) for fotagliptin versus placebo, and -0.46% (95% CI: -0.67% to -0.26%) for alogliptin versus placebo, and 0.02% (95%CI: -0.16% to 0.19%; upper limit of 95%CI < margin of 0.4%) for fotagliptin versus alogliptin. So fotagliptin was non-inferior to alogliptin. Compared with subjects with placebo (15.5%), significantly more patients with fotagliptin (37.0%) and alogliptin (35.5%) achieved HbA1c < 7.0% after 24 weeks of treatment. During the whole 52 weeks of treatment, the overall incidence of hypoglycemia was low for both of the fotagliptin and alogliptin groups (1.0% each). No drug-related serious adverse events were observed in any treatment group. CONCLUSIONS In summary, the study demonstrated improvement in glycemic control and a favorable safety profile for fotagliptin in treatment-naive patients with T2DM. TRIAL REGISTRATION ClinicalTrail.gov NCT05782192.
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Affiliation(s)
- Mingtong Xu
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kan Sun
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wenjie Xu
- Shenzhen Salubris Pharmaceuticals Co., Ltd, Shenzhen, China
| | - Chuan Wang
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Dewen Yan
- Shenzhen Second People's Hospital, Shenzhen, China
| | - Shu Li
- Huizhou Municipal Central Hospital, Huizhou, China
| | - Li Cong
- The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Yinzhen Pi
- The First Hospital of Changsha, Changsha, China
| | - Weihong Song
- Chenzhou First People's Hospital, Chenzhou, China
| | | | - Rijun Xiao
- The First Peole's Hospital of Xiangtan City, Xiangtan, China
| | | | - Jianping Wang
- The Second Affiliated Hospital of the University of South China, Hengyang, China
| | - Hui Peng
- Yichun People's Hospital, The Affiliated Hospital of Yichun University, Yichun, China
| | - Yawei Zhang
- Pingxiang People's Hospital, Pingxiang, China
| | - Peng Duan
- The People's Hospital of Nanchang, The Third Hospital of Nanchang, Nanchang, China
| | - Meiying Zhang
- The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianying Liu
- The First Affiliated Hospital of Nanchang University, Nanchang, China
| | | | - Xuefeng Li
- Taihe Hospital, Affilited Hospital of Hubei University of Medicine, Shiyan, China
| | - Yan Bao
- Renmin Hospital of Wuhan University, Wuhan, China
| | - Tianshu Zeng
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Wang
- Nanjing Jiangning Hospital, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Li Qin
- Chongming Branch, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chaoming Wu
- The 2nd School of Medicine, WMU, The 2nd Affiliated Hospital and Yuying Children's Hospital of WMU, Wenzhou, China
| | | | - Chenghu Huang
- Bishan Hospital of Chongqing, Bishan Hospital of Chongqing Medical University, Chongqing, China
| | - Shuang Yan
- Fourth affiliated hospital of Harbin Medical University, Harbin, China
| | - Wei Zhang
- The First Hospital of Qiqihar, Qiqihar, China
| | - Meizi Li
- The Affiliated Hospital of Yanbian University, Yanbian, China
| | - Li Sun
- Siping Central People's Hospital, Siping, China
| | - Yanjun Wang
- The Second Norman Bethune Hospital of Jilin University, Jilin, China
| | - HongMei Li
- Emergency General Hospital, Beijing, China
| | - Guang Wang
- Beijing Chao-Yang Hospital, Capital Medicine University, Beijing, China
| | - Shuguang Pang
- Jinan Central Hospital, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | | | | | - Fujun Wang
- The Fourth Hospital of He Bei Medical University, Shijiazhuang, China
| | - Xiuhai Su
- Cangzhou Hospital of Integrated TCM-WM Heibei, Cangzhou, China
| | - Yujin Ma
- The First Affiliated Hospital and College of Clinical Medicine, Henan University of Science and Technology, Luoyang, China
| | - Wei Zhang
- Puyang Oilfield General Hospital, Puyang, China
| | - Ziling Li
- Inner Mongolia Baogang Hospita, Baotou, China
| | - Zuoling Xie
- Zhongda Hospital Southeast University, Nanjing, China
| | - Ning Xu
- The First People's Hospital of Lianyungang, Lianyungang, China
| | - Lin Ni
- The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou Teacher College, Huzhou, China
| | - Li Zhang
- Hainan Third People's Hospital, Sanya, China
| | | | - Tianrong Pan
- The Second Hospital of Anhui Medical University, Hefei, China
| | - Qijuan Dong
- People's Hospital of Zhengzhou, People's Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Xiaohong Wu
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | | | - Xin Zhang
- Genertec Liaoyou Gem Flowe Hospital, Panjin, China
| | - Qijing Zou
- The Central Hospital of Yougzhou, Yongzhou, China
| | | | - Jue Xi
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | | | - Jingchao Sun
- Shenzhen Salubris Pharmaceuticals Co., Ltd, Shenzhen, China
| | - Li Yan
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
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