Avandia™ + Amaryl™ or Avandamet™ Compared With Metformin (AVALANCHE™ Study)

Canadian Heart Research Centre391 enrolled

Overview

The incidence of type 2 diabetes is on the increase. According to recent Canadian Diabetes Association guidelines glucose control, based on the A1C measurement, needs to be achieved within a 6-12 month period of time after the initial diagnosis of type 2 diabetes. The guidelines on the use of antihyperglycemic agents identify the potential benefits of sub-maximal oral combination therapy in order to achieve more rapid and improved glycemic control compared with higher dose monotherapy. Furthermore, many patients on prolonged oral antihyperglycemic monotherapy who then start on combination therapy may not achieve the required target glycemic control. Indeed early initiation of combination therapies may be necessary to achieve and maintain glycemic targets because of the progressive deterioration of pancreatic β cell function and glycemic control.

AvandametTM combines two oral antihyperglycemic agents, rosiglitazone maleate and metformin hydrochloride, with different but complementary mechanisms of action to improve glycemic control while reducing circulating insulin levels in patients with type 2 diabetes. AvandiaTM and AmarylTM combine two antidiabetic agents, rosiglitazone maleate and glimepiride. Glimepiride is an effective antihyperglycemic agent which has a low incidence of hypoglycemia, symptomatic hypoglycemia, severe hypoglycemia, and confirmed hypoglycemia. Subjects in this study who are inadequately controlled on diet, exercise and a submaximal dose of metformin or sulfonylurea (SU) will be randomized to either a combination of metformin plus rosiglitazone (AvandametTM) or a combination of AvandiaTM + AmarylTM or a Metformin monotherapy arm. As per the Canadian Diabetes Association (CDA) guidelines, their fasting plasma glucose and A1C to be 7 (mmol/L / percent) or less throughout the study. If the subject does not achieve the target then either AvandametTM or AvandiaTM and AmarylTM or Metformin will be up-titrated in an effort to reach this CDA recommended target. This study will attempt to demonstrate that the either combination arm of rosiglitazone plus metformin (AvandametTM) or the other combination arm of AvandiaTM + AmarylTM will provide greater glycemic control while avoiding the side-effects associated with the use of maximal dose metformin.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Interventions

AvandametDRUG

Avandamet 2 / 500 mg twice daily titration up to 4 mg / 1000 mg twice daily compared to Avandia 4 mg and Amaryl 1 mg once daily over 6 months or compared to Metformin 500 mg twice daily up to 1000 mg over 6 months.

Avandia and AmarylDRUG

Avandia 4 mg and Amaryl 1 mg once daily compared to Avandamet 2 / 500 mg twice daily titration up to 4 mg / 1000 mg twice daily, or compared to Metformin 500 mg twice daily up to 1000 mg over 6 months.

MetforminDRUG

Metformin 500 mg twice daily up to 1000 mg over 6 months compared to Avandia 4 mg and Amaryl 1 mg once daily or compared to Avandamet 2 / 500 mg twice daily titration up to 4 mg / 1000 mg twice daily

Eligibility

Sex: ALLMin age: 18 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Type 2 diabetes patients 2. 18 - 75 years old 3. Type 2 diabetes mellitus (DM) drug naïve or on submaximal oral monotherapy \< 3 years 4. A1C criteria at screening: 1. 7.1-10% for drug naïve patients after failure of diet control and life-style modification 2. 7.1 - 9% on single therapy (e.g. not more 10 mg of Glyburide or 4 mg of Amaryl™ or 1000mg of Metformin) who will start after 2 weeks wash-out. During wash out the following will be done: i) diet and life style modification ii) Angiotensin converting enzyme inhibitor (ACE), aspirin (80 mg), and statin if appropriate 5. Signed informed consent Exclusion Criteria: 1. Type 1 diabetes 2. Subjects currently treated with insulin 3. Subject treated for previous 3 month with any thiazolidinedione (TZD) 4. Evidence of clinically significant concomitant illnesses which are not controlled by medication and/or may limit participation in the study as judged by the investigator 5. Subjects who have hypersensitivity to any components of study drugs 6. Participation in a clinical trial and/or intake of an investigational drug within 30 days prior to screening. 7. Pregnant or nursing females 8. Females of childbearing potential who are not on adequate birth control 9. Liver enzymes (Alanine Aminotransferase (ALT) \> 2.5 times upper limit of normal) 10. Renal impairment: serum creatinine ≥ 136umol/L (males) and ≥ 124 umol/L (females) 11. Congestive Heart Failure (CHF class III/IV) 12. Weight \>160 kg

Outcomes

Primary Outcomes

Mean Change From Baseline in A1C at Month 6

Change from baseline was calculated as the Month 6 value minus the baseline value, with last on-treatment observation carried forward (LOCF) from Month 2 for withdrawn subjects or missing values.

Time frame: Baseline and Month 6

Secondary Outcomes

Mean Change From Baseline in A1C at Month 4

Change from baseline was calculated as the Month 4 value minus the baseline value, with last on-treatment observation carried forward (LOCF) from Month 2 for withdrawn subjects or missing values.

Time frame: Baseline and Month 4

Mean Change From Baseline in A1C at Month 12

Change from baseline was calculated as the Month 12 value minus the baseline value, with last on-treatment observation carried forward (LOCF) from Month 2 for withdrawn subjects or missing values.

Time frame: Baseline and Month 12

Number of Subjects Achieving A1C Target at Month 4

A1C responders were described as subjects having achieved A1C less than 7 percent at Month 4, with LOCF from Month 2.

Time frame: Month 4

Number of Subjects Achieving A1C Target at Month 6

A1C responders were described as subjects having achieved A1C less than 7 percent at Month 6, with LOCF from Month 2.

Time frame: Month 6

Number of Subjects Achieving A1C Target at Month 12

A1C responders were described as subjects having achieved A1C less than 7 percent at Month 12 with LOCF from Month 2.

Time frame: Month 12

Mean Change From Baseline in Fasting Plasma Glucose (FPG) at Month 4

Change from baseline was calculated as the Month 4 value minus the baseline value, with last on-treatment observation carried forward (LOCF) from Month 2 for withdrawn subjects or missing values.

Time frame: Baseline and Month 4

Mean Change From Baseline in Fasting Plasma Glucose (FPG) at Month 6

Change from baseline was calculated as the Month 6 value minus the baseline value, with last on-treatment observation carried forward (LOCF) from Month 2 for withdrawn subjects or missing values.

Time frame: Baseline and Month 6

Mean Change From Baseline in Fasting Plasma Glucose (FPG) at Month 12

Change from baseline was calculated as the Month 12 value minus the baseline value, with LOCF from Month 2 for withdrawn subjects or missing values.

Time frame: Baseline and Month 12

Number of Subjects Achieving FPG Target at Month 4

FPG responders were described as subjects having achieved FPG less than 7 mmol/L at Month 4 with LOCF from Month 2.

Time frame: Month 4

Number of Subjects Achieving FPG Target at Month 6

FPG responders were described as subjects having achieved FPG less than 7 mmol/L at Month 6 with LOCF from Month 2.

Time frame: Month 6

Number of Subjects Achieving FPG Target at Month 12

FPG responders were described as subjects having achieved FPG less than 7 mmol/L at Month 12 with LOCF from Month 2.

Time frame: Month 12

Mean Change From Baseline in 5 Year UKPDS Risk Scores at Month 6

Change from baseline was calculated as the Month 6 value minus the baseline value, with LOCF from Month 2. The UKPDS (United Kingdom Prospective Diabetes Study) risk engine calculated was based on 5 years risk using gender, race, age at diagnosis of diabetes, duration of diabetes, smoking status, A1C, systolic blood pressure and total cholesterol to high-density lipoprotein (HDL) ratio at a specified visit. The UKPDS cardiovascular disease (CVD) risk engine is used to estimate the risk of having coronary heart disease in type II diabetes according to the UKPDS model. The possible risk scores can range from 0 to 100% and hence lower scores would predict a person is less likely to have an event.

Time frame: Baseline and Month 6

Mean Change From Baseline in 5 Year UKPDS Risk Scores at Month 12

Change from baseline was calculated as the Month 12 value minus the baseline value, with LOCF from Month 2. The UKPDS (U.K. Prospective Diabetes Study) risk engine calculated was based on 5 years risk using gender, race, age at diagnosis of diabetes, duration of diabetes, smoking status, A1C, systolic blood pressure and total cholesterol to HDL ratio at a specified visit. The UKPDS cardiovascular disease (CVD) risk engine is used to estimate the risk of having coronary heart disease in type II diabetes according to the UKPDS model. The possible risk scores can range from 0 to 100% and hence lower scores would predict a person is less likely to have an event.

Time frame: Baseline and Month 12

Mean Change From Baseline in C-reactive Protein (CRP) at Month 6

Change from baseline was calculated as the Month 6 value minus the baseline value. LOCF was not used for this analysis. CRP was only done at baseline, months 6 and 8. The test was optional and performed only by participating sites.

Time frame: Baseline and Month 6

Mean Change From Baseline in C-reactive Protein (CRP) at Month 12

Change from baseline was calculated as the Month 12 value minus the baseline value, with LOCF from Month 6. CRP was only done at baseline, months 6 and 12. The test was optional and performed only by participating sites.

Time frame: Baseline and Month 12

Mean Change From Baseline in Adiponectin at Month 6

Change from baseline was calculated as the Month 6 value minus the baseline value. LOCF was not used for this analysis. Adiponectin was only done at baseline, months 6 and 12. The test was optional and performed only by participating sites.

Time frame: Baseline and Month 6

Mean Change From Baseline in Adiponectin at Month 12

Change from baseline was calculated as the Month 12 value minus the baseline value, with LOCF from Month 6. Adiponectin was only done at baseline, months 6 and 12. The test was optional and performed only by participating sites.

Time frame: Baseline and Month 12

Avandia™ + Amaryl™ or Avandamet™ Compared With Metformin (AVALANCHE™ Study)

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes