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Dapagliflozin is effective as add-on therapy to Sitagliptin with or without Metformin in patients with type 2 diabetes mellitus


The aim was to assess the efficacy and safety of Dapagliflozin ( Forxiga ) as add-on therapy in patients with type 2 diabetes who were inadequately controlled with a dipeptidyl peptidase-4 inhibitor with or without Metformin ( Glucophage ).

In this 24-week, multicenter, randomized, double-blind, placebo-controlled, parallel-group, phase 3 study with a 24-week blinded extension period, 432 patients were randomized to receive Dapagliflozin 10 mg/day or placebo added to Sitagliptin ( Januvia ) ( 100 mg/day ) with or without Metformin ( greater than or equal to 1,500 mg/day ).

Baseline glycated haemoglobin ( HbA1c ) and fasting plasma glucose ( FPG ) levels were 7.9% ( 63.0 mmol/mol ) and 162.2 mg/dL ( 9.0 mmol/L ) for the Dapagliflozin group and 8.0% ( 64.0 mmol/mol ) and 163 mg/dL ( 9.0 mmol/L ) for placebo.

At week 24, Dapagliflozin has significantly reduced mean HbA1c levels ( -0.5% [ -4.9 mmol/mol ] ) versus placebo ( 0.0% [ +0.4 mmol/mol ] ).

Dapagliflozin has reduced body weight versus placebo ( -2.1 and -0.3 kg ) and has reduced HbA1c levels in patients with baseline values greater than or equal to 8.0% ( -0.8% [ 8.7 mmol/mol ] and 0.0% [ 0.3 mmol/mol ] ) and fasting plasma glucose levels ( -24.1 mg/dL [ -1.3 mmol/L ] and 3.8 mg/dL [ 0.2 mmol/L ] ).

Similar results were observed when data were stratified by background therapy.

Glycemic and weight benefits observed at week 24 were maintained through week 48. Changes from baseline in systolic blood pressure at week 8 were not significantly different between treatment groups.

Over 48 weeks, fewer patients receiving Dapagliflozin were discontinued or rescued for failing to achieve glycemic targets compared with placebo.

Adverse events were balanced between groups, and discontinuation rates were low. At week 48, signs and symptoms suggestive of genital infection were more frequent with Dapagliflozin ( 9.8% ) than with placebo ( 0.4% ). Signs and symptoms suggestive of urinary tract infection were balanced between Dapagliflozin ( 6.7% ) and placebo ( 6.2% ).

In conclusion, these results suggest that in patients with type 2 diabetes, inadequately controlled on Sitagliptin with or without Metformin, add-on treatment with Dapagliflozin provides additional clinical benefit and is well tolerated. ( Xagena )

Jabbour SA et al, Diabetes Care 2014; 37: 740-750

XagenaMedicine_2014



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