Takahisa Hirose1, Chihiro Saitoh2, Ichiro Oikawa2, Nobuo Kondo2,3. 1. 1Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541 Japan. 2. Clinical Development Department, EA Pharma Co., Ltd., 2-1-1 Irifune, Chuo-ku, Tokyo, 104-0042 Japan. 3. 3Present Address: University Research Administration Center, Tokyo University of Science, 1-3 Kagurazaka, Shinjuku-ku, Tokyo, 162-8601 Japan.
Abstract
BACKGROUND: Combination therapies of drugs with distinct mechanisms of action are emerging as ways to achieve strict glycemic control, thus preventing the onset and progression of diabetic complications in type 2 diabetes patients. A rapid-acting insulin secretagog, nateglinide, and a potent dipeptidyl peptidase-4 inhibitor, sitagliptin, meet such criteria. METHODS: A total of 121 patients inadequately controlled with sitagliptin monotherapy received 52-week combination therapy (nateglinide + sitagliptin). The primary endpoint was the safety of the therapy, and its efficacy was also evaluated. A meal tolerance test was performed 4 weeks before the start of combination therapy (week -4) and at week 24 and week 52 after the start of combination therapy. RESULTS: HbA1c levels were lower at week 52 than at week 0 [-0.42% (95% confidence interval -0.53, -0.31)]. Fasting plasma glucose levels tended to decrease from baseline (week 0) to week 52 [-4.8 mg/dl (-9.4, -0.2)]. In the meal tolerance test, postprandial plasma glucose levels and area under the curve of glucose from before to 2 h after the meal load were lower at week 24 and week 52 than at week -4. In addition, the levels of insulin and active glucagon-like peptide-1 were higher at week 52 than at week -4. Furthermore, the incidence of adverse events in combination therapy with sitagliptin was similar to those previously shown in nateglinide monotherapy. CONCLUSION: Compared with sitagliptin monotherapy, the combination therapy of nateglinide plus sitagliptin was more effective in type 2 diabetes patients at improving glycemic control while showing similar safety.
BACKGROUND: Combination therapies of drugs with distinct mechanisms of action are emerging as ways to achieve strict glycemic control, thus preventing the onset and progression of diabetic complications in type 2 diabetes patients. A rapid-acting insulin secretagog, nateglinide, and a potent dipeptidyl peptidase-4 inhibitor, sitagliptin, meet such criteria. METHODS: A total of 121 patients inadequately controlled with sitagliptin monotherapy received 52-week combination therapy (nateglinide + sitagliptin). The primary endpoint was the safety of the therapy, and its efficacy was also evaluated. A meal tolerance test was performed 4 weeks before the start of combination therapy (week -4) and at week 24 and week 52 after the start of combination therapy. RESULTS: HbA1c levels were lower at week 52 than at week 0 [-0.42% (95% confidence interval -0.53, -0.31)]. Fasting plasma glucose levels tended to decrease from baseline (week 0) to week 52 [-4.8 mg/dl (-9.4, -0.2)]. In the meal tolerance test, postprandial plasma glucose levels and area under the curve of glucose from before to 2 h after the meal load were lower at week 24 and week 52 than at week -4. In addition, the levels of insulin and active glucagon-like peptide-1 were higher at week 52 than at week -4. Furthermore, the incidence of adverse events in combination therapy with sitagliptin was similar to those previously shown in nateglinide monotherapy. CONCLUSION: Compared with sitagliptin monotherapy, the combination therapy of nateglinide plus sitagliptin was more effective in type 2 diabetes patients at improving glycemic control while showing similar safety.
Authors: Nicola A Duffy; Brian D Green; Nigel Irwin; Victor A Gault; Aine M McKillop; Finbarr P M O'Harte; Peter R Flatt Journal: Eur J Pharmacol Date: 2007-05-13 Impact factor: 4.432