Clinical trial NCT02630706: A Study to Evaluate the Efficacy and Safety of Ertugliflozin in Asian Participants With Type 2 Diabetes and Inadequate Glycemic Control on Metformin Monotherapy (MK-8835-012)
Official title: A Phase 3, Randomized, Double-Blind, Placebo-Controlled, 26-Week Multicenter Study to Evaluate the Efficacy and Safety of Ertugliflozin in Asian Subjects With Type 2 Diabetes Mellitus and Inadequate Glycemic Control on Metformin Monotherapy (VERTIS-ASIA)
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE3
Conditions: Type 2 Diabetes Mellitus
Lead sponsor: Merck Sharp & Dohme LLC
Sponsor class: INDUSTRY
Collaborators: name: Pfizer
First posted: 2015-12-15
Enrollment: 506
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This is a study to evaluate the efficacy and safety of the addition of ertugliflozin to metformin monotherapy in Asian participants with Type 2 diabetes mellitis (T2DM) who have inadequate glycemic control on metformin monotherapy. The primary hypothesis is that the mean reduction from baseline in HbA1C for 15 mg and 5 mg ertugliflozin (tested sequentially) is greater than for placebo.

Detailed description: This study includes a 1-week screening period, an 8-week (or greater) antihyperglycemic agent (AHA) wash-off and/or metformin dose stable period (as necessary), a 2-week single-blind placebo run-in period, a 26-week double-blind treatment period, and a post-treatment telephone contact 14 days after the last dose of study drug.

Eligibility criteria: Inclusion Criteria:

* Asian participants ≥18 years of age at the time of initial Screening.
* Type 2 diabetes mellitus as per American Diabetes Association guidelines.
* Metformin monotherapy (≥1500 mg/day) with an initial Screening A1C of 7.0-10.5% (53-91 mmol/mol) OR metformin monotherapy (\<1500 mg/day) with an initial Screening A1C of 7.5-11.0% (58-97 mmol/mol) OR dual combination therapy with metformin + sulfonylurea, dipeptidyl peptidase-4 (DDP-4) inhibitor, meglitinide, or alpha-glucosidase inhibitor with an initial Screening A1C of 6.5-9.5% (48-80 mmol/mol).
* Body mass index (BMI) ≥18.0 kg/m\^2.
* Male or female not of reproductive potential.
* Female of reproductive potential who agrees to remain abstinent from heterosexual activity or to use 2 acceptable combinations of contraception.

Exclusion Criteria:

* History of type 1 diabetes mellitus or a history of ketoacidosis.
* History of other specific types of diabetes (e.g., genetic syndromes, secondary pancreatic diabetes, diabetes due to endocrinopathies, drug- or chemical-induced, and post-organ transplant.)
* History of myocardial infarction, unstable angina, arterial revascularization, stroke, transient ischemic attack, or New York Heart Association (NYHA) functional class III-IV heart failure within 3 months of study start.
* Mean value for triplicate screening sitting systolic blood pressure \>160 mm Hg and/or diastolic blood pressure \>90 mm Hg after at least a 5-minute seated rest at screening
* Active, obstructive uropathy or indwelling urinary catheter.
* History of malignancy ≤5 years prior to study start, except for adequately treated basal cell or squamous cell skin cancer or in situ cervical cancer.
* Routinely consumes \>2 alcoholic drinks per day or \>14 alcoholic drinks per week or engages in binge drinking.
* Any clinically significant malabsorption condition.
* Is on a weight-loss program or weight-loss medication or other medication associated with weight changes and is not weight stable prior to study start.
* Has undergone bariatric surgery within the past 12 months or \>12 months and is not weight stable prior to study start.
* A known hypersensitivity or intolerance to any sodium glucose co-transporter (SGLT2) inhibitor.
* On a previous clinical study with ertugliflozin.
* Is taking blood pressure or lipid altering medications that have not been on a stable dose for at least 4 weeks prior to study start.
* Current treatment for hyperthyroidism.
* Male participants with a serum creatinine \>=1.3 mg/dL (\>=115 mol/L) or female participants with a serum creatinine \>=1.2 mg/dL (\>=106 mol/L) or participants with an estimated glomerular filtration rate (eGFR) \<55 mL/min/1.73m\^2 according to the 4-variable Modification of Diet in Renal Disease (MDRD) equation at screening.
* An aspartate transaminase (AST) or alanine transaminase (ALT) \>2X the upper limit of normal (ULN) range at screening, or a total bilirubin \>1.5 X the ULN unless the participant has a history of Gilbert's.
* On thyroid replacement therapy and has not been on a stable dose for at least 6 weeks prior to study start.
* A medical history of active liver disease (other than non-alcoholic hepatic steatosis), including chronic active hepatitis B or C, primary biliary cirrhosis, or symptomatic gallbladder disease.
* Has been treated with any of the following agents within 12 weeks of study start or during the pre-randomization period: Insulin of any type (except for short-term use during concomitant illness or other stress), other injectable anti-hyperglycemic agents (e.g., pramlintide, exenatide, liraglutide), another SGLT2 inhibitor, bromocriptine, colesevelam, rosiglitazone or pioglitazone, or any other AHA with the exception of the protocol-approved agents.
* Is on or likely to require treatment ≥14 consecutive days or repeated courses of pharmacologic doses of corticosteroids.
* Has undergone a surgical procedure within 6 weeks prior to study start or has planned major surgery during the study.
* Pregnant or breast-feeding, or planning to conceive during the trial, including 14 days following the last dose of study medication.
* Planning to undergo hormonal therapy in preparation for egg donation during the trial, including 14 days following the last dose of study medication.
* Donated blood or blood products within 6 weeks of study start.
* Has Human Immunodeficiency Virus (HIV).
* Has blood dyscrasias or any disorders causing hemolysis or unstable red blood cells.
* Has clinically important hematological disorders (such as aplastic anemia, myeloproliferative or myelodyplastic syndromes, thrombocytopenia.)

Primary outcomes:
measure: Change From Baseline in A1C (%) at Week 26 (Excluding Rescue Approach)
timeFrame: Baseline and Week 26
measure: Change From Baseline in A1C (%) at Week 26 (Excluding Rescue Approach) (China Subpopulation)
timeFrame: Baseline and Week 26
measure: Percentage of Participants Experiencing An Adverse Event (AE) (Including Rescue Approach)
timeFrame: Up to 28 weeks
measure: Percentage of Participants Experiencing An Adverse Event (AE) (Including Rescue Approach) (China Subpopulation)
timeFrame: Up to 28 weeks
measure: Percentage of Participants Discontinuing Study Treatment Due to an AE (Including Rescue Approach)
timeFrame: Up to 26 weeks
measure: Percentage of Participants Discontinuing Study Treatment Due to an AE (Including Rescue Approach) (China Subpopulation)
timeFrame: Up to 26 weeks
Secondary outcomes:
measure: Change From Baseline in Fasting Plasma Glucose at Week 26 (Excluding Rescue Approach)
timeFrame: Baseline and Week 26
measure: Change From Baseline in Fasting Plasma Glucose at Week 26 (Excluding Rescue Approach) (China Subpopulation)
timeFrame: Baseline and Week 26
measure: Change From Baseline in Body Weight at Week 26 (Excluding Rescue Approach)
timeFrame: Baseline and Week 26
measure: Change From Baseline in Body Weight at Week 26 (Excluding Rescue Approach) (China Subpopulation)
timeFrame: Baseline and Week 26
measure: Percentage of Participants With HbA1c of <7.0% (53 mmol/Mol) (Logistic Regression Using Multiple Imputation Based on cLDA Model: Excluding Rescue Approach)
timeFrame: Week 26
measure: Percentage of Participants With HbA1c of <7.0% (53 mmol/Mol) (Logistic Regression Using Multiple Imputation Based on cLDA Model: Excluding Rescue Approach) (China Subpopulation)
timeFrame: Week 26
measure: Change From Baseline in Sitting Systolic Blood Pressure at Week 26 (Excluding Rescue Approach)
timeFrame: Baseline and Week 26
measure: Change From Baseline in Sitting Systolic Blood Pressure at Week 26 (Excluding Rescue Approach) (China Subpopulation)
timeFrame: Baseline and Week 26
measure: Change From Baseline in Sitting Diastolic Blood Pressure at Week 26 (Excluding Rescue Approach)
timeFrame: Baseline and Week 26
measure: Change From Baseline in Sitting Diastolic Blood Pressure at Week 26 (Excluding Rescue Approach) (China Subpopulation)
timeFrame: Baseline and Week 26
measure: Percentage of Participants With HbA1c of <6.5% (48 mmol/Mol) at Week 26 (Logistic Regression Using Multiple Imputation: Excluding Rescue Approach)
timeFrame: Week 26
measure: Percentage of Participants With HbA1c of <6.5% (48 mmol/Mol) at Week 26 (Logistic Regression Using Multiple Imputation: Excluding Rescue Approach) (China Subpopulation)
timeFrame: Week 26
measure: Percentage of Participants Requiring Glycemic Rescue Therapy Through Week 26.
timeFrame: Week 26
measure: Percentage of Participants Requiring Glycemic Rescue Therapy Through Week 26 (China Subpopulation)
timeFrame: Week 26
measure: Time to Glycemic Rescue Therapy
timeFrame: Up to 183 days
measure: Time to Glycemic Rescue Therapy (China Subpopulation)
timeFrame: Up to 149 days
measure: Ertugliflozin Plasma Concentrations Summary Statistics Over Time: Including Rescue Approach
timeFrame: Week 6: Pre-Dose
measure: Ertugliflozin Plasma Concentrations Summary Statistics Over Time: Including Rescue Approach
timeFrame: Week 12: Pre-Dose
measure: Ertugliflozin Plasma Concentrations Summary Statistics Over Time: Including Rescue Approach
timeFrame: Week 12: 60 min. Post-Dose
measure: Ertugliflozin Plasma Concentrations Summary Statistics Over Time: Including Rescue Approach
timeFrame: Week 18: Pre-Dose
measure: Ertugliflozin Plasma Concentrations Summary Statistics Over Time: Including Rescue Approach
timeFrame: Week 18: 60 min. Post-Dose
measure: Ertugliflozin Plasma Concentrations Summary Statistics Over Time: Including Rescue Approach
timeFrame: Week 26: Pre-Dose
measure: Ertugliflozin Plasma Concentrations Summary Statistics Over Time: Including Rescue Approach (China Subpopulation)
timeFrame: Week 6: Pre-Dose
measure: Ertugliflozin Plasma Concentrations Summary Statistics Over Time: Including Rescue Approach (China Subpopulation)
timeFrame: Week 12: Pre-Dose
measure: Ertugliflozin Plasma Concentrations Summary Statistics Over Time: Including Rescue Approach (China Subpopulation)
timeFrame: Week 12: 60 min. Post-Dose
measure: Ertugliflozin Plasma Concentrations Summary Statistics Over Time: Including Rescue Approach (China Subpopulation)
timeFrame: Week 18: Pre-Dose
measure: Ertugliflozin Plasma Concentrations Summary Statistics Over Time: Including Rescue Approach (China Subpopulation)
timeFrame: Week 18: 60 min. Post-Dose
measure: Ertugliflozin Plasma Concentrations Summary Statistics Over Time: Including Rescue Approach (China Subpopulation)
timeFrame: Week 26: Pre-Dose
Other outcomes:
Locations:
Study officials:
affiliation: Merck Sharp & Dohme LLC
name: Medical Director
role: STUDY_DIRECTOR
References:
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citation: Fediuk DJ, Sahasrabudhe V, Dawra VK, Zhou S, Sweeney K. Population Pharmacokinetic Analyses of Ertugliflozin in Select Ethnic Populations. Clin Pharmacol Drug Dev. 2021 Nov;10(11):1297-1306. doi: 10.1002/cpdd.970. Epub 2021 Jul 2.
citation: Ji L, Liu Y, Miao H, Xie Y, Yang M, Wang W, Mu Y, Yan P, Pan S, Lauring B, Liu S, Huyck S, Qiu Y, Terra SG. Safety and efficacy of ertugliflozin in Asian patients with type 2 diabetes mellitus inadequately controlled with metformin monotherapy: VERTIS Asia. Diabetes Obes Metab. 2019 Jun;21(6):1474-1482. doi: 10.1111/dom.13681. Epub 2019 Apr 5.