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Efficacy and Safety of a Fixed Dose Combination of Remogliflozin Etabonate and Vildagliptin in Patients with Type-2 Diabetes Mellitus: A Randomized, Active-Controlled, Double-Blind, Phase III Study.

Remogliflozin Etabonate (RE) & Vildagliptin are twice-daily medications that are individually approved and widely used in India for the treatment of diabetes. A single pill fixed dose combination of RE & Vildagliptin was formulated as potential pharmaco-therapeutic agent that would not only offer beneficial pharmacologic effects, but also reduces the pill burden, leading to a simplified treatment regimen with better treatment compliance. The fixed dose combination (FDC) of Remogliflozin + Vildagliptin added on to Metformin has been evaluated in this pivotal phase III study.


MATERIAL
This 16 week, multi-centric, prospective, double blind, double dummy, parallel group, randomized controlled study compared efficacy and safety of FDC of RE 100mg + Vildagliptin 50mg (RV) given twice daily with active comparator of Empagliflozin 25mg +Linagliptin 5mg (EL) given once daily. Adult T2DM patients with HbA1c 8-11% on Metformin stable dose of ≥1500mg for ≥8 weeks before screening were randomized to either of treatment arms. The study endpoints were mean changes from baseline (CFB) in HbA1c (primary), fasting plasma glucose (FPG), post-prandial plasma glucose (PPG), body weight (BW) and blood pressure (BP) for efficacy and adverse events (AE) monitoring for safety assessments.


OBSERVATION
Of 400 eligible subjects (200 in each arm), 357 (89.3%) subjects completed the study. The baseline demographic characteristics were well balanced between 2 treatment arms. In the mITT population, the least squares (LS) mean (SE) change from baseline in HbA1c levels at week 16 was -1.46% (0.098) in the RV arm and -1.38% (0.100) in the EL arm (p < 0.001 for within group change from baseline). The mean difference of -0.08% (95%CI: -0.28, 0.13) in HbA1c demonstrated non-inferiority (NI) of RV compared to EL (p<0.001 for NI test). Similarly, significant reduction was observed in FPG, PPG, BW and BP which was found to be comparable between the two treatment arms. Drug related AEs were observed in 5.5% and 4.5% subjects of EL and RV arm respectively, with low incidence of hypoglycemia, genital and urinary tract infections (0.5-3%).


CONCLUSION
Overall, FDC of Remogliflozin Etabonate + Vildagliptin added on to Metformin was found to be efficacious and well tolerated in the treatment of patients with T2DM, and demonstrated non-inferiority to Empagliflozin 25mg + Linagliptin 5mg treatment added on to Metformin.