Dapagliflozin plus saxagliptin regimen shows promise for poorly controlled type 2 diabetes
medwireNews: Dapagliflozin plus saxagliptin offers a realistic alternative to both insulin and glimepiride in patients with type 2 diabetes poorly controlled by metformin, show two studies presented at the ADA’s 78th Scientific Sessions in Orlando, Florida, USA.
Serge Jabbour (Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA) reported that the reduction in glycated hemoglobin (HbA1c) from baseline to week 24 with dapagliflozin 10 mg/day plus saxagliptin 5 mg/day was noninferior to that with titrated insulin glargine, when both treatments were added to metformin (≥1500 mg/day) with or without a sulfonylurea (≥50% maximum dose).
Specifically, the mean reduction in HbA1c at 24 weeks was 1.7%, from a baseline level of 9.0%, in the 324 patients randomly assigned to receive dapagliflozin plus saxagliptin and 1.5%, from a baseline of 9.1%, in the 319 assigned to receive insulin, a difference that was not statistically significant.
Juan Frias (National Research Institute, Los Angeles, California) showed that adding dapagliflozin plus saxagliptin to metformin with or without a sulfonylurea results in a significantly greater reduction in HbA1c at 52 weeks than does the addition of titrated glimepiride 1–6 mg/day. The mean reduction was 1.35% among 227 randomly assigned patients in the former group and 0.98% among 216 patients in the latter group, from respective baseline levels of 8.4% and 8.5%.
The proportion of patients achieving an HbA1c below 7% was similar between dapagliflozin plus saxagliptin and insulin but was significantly greater with dapagliflozin plus saxagliptin than with glimepiride.
In both phase IIIb trials, however, dapagliflozin plus saxagliptin was associated with a greater degree of weight loss and a lower rate of hypoglycemia, and a significant increase in the proportion of patients achieving a glycated hemoglobin level below 7% without weight gain or hypoglycemia.
In addition, patients receiving dapagliflozin plus saxagliptin had a significantly lower rate of treatment intensification and a significantly greater reduction in systolic blood pressure than those receiving glimepiride.
Both researchers reported that each of the treatments was well tolerated with no new safety concerns.
By Laura Cowen
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