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Efficacy and Safety of TAK-559 Combined With Glyburide in Treating Subjects With Type 2 Diabetes Mellitus. (ORIGAMI)

Primary Purpose

Diabetes Mellitus

Status
Terminated
Phase
Phase 3
Locations
Study Type
Interventional
Intervention
TAK-559 and glyburide
TAK-559 and glyburide
Glyburide
Sponsored by
Takeda
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetes Mellitus focused on measuring Glucose Metabolism Disorder, Dysmetabolic Syndrome, Type II Diabetes, Diabetes Mellitus, Lipoatrophic, Dyslipidemia, Drug Therapy

Eligibility Criteria

25 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Must be diagnosed with type 2 diabetes mellitus using American Diabetes Association diagnostic criteria, and on a stable dose of an oral anti-diabetic monotherapy prior to Screening A.
  • Has a glycosylated hemoglobin level greater than or equal to 8.0% and less than or equal to 10.0% at Screening B.
  • Has a fasting plasma glucose greater than or equal to 126 mg/dL (7.0 mmol/L) at Screening B.
  • Is taking a stable dose of at least 10 mg of glyburide for at least 10 days prior to Screening B.
  • Has a stable or worsening self-monitoring blood glucose level while taking glyburide.
  • The patient must have a low-density lipoprotein less than 160 mg/dL (4.1 mmol/L) at Screening A.
  • Has a body mass index less than or equal to 45 kg/m2 at Screening A.
  • Is willing to be counseled by the investigator or designee to follow an individualized, weight-maintaining diet during the study period.
  • Has evidence of insulin secretory capacity as demonstrated by a C-peptide concentration of greater than or equal to 1.5 ng/mL (0.50 nmol/L) at Screening A, and if necessary, after a repeat at Screening B.
  • The patient must be able to perform daily self-monitoring blood glucose tests throughout the study.
  • Has a normal thyroid-stimulating hormone level of less than 5.5 uIU/mL (5.5 mIU/L) and greater than or equal to 0.35 uIU/mL (0.35 mIU/L) at Screening A.
  • Is in good health as determined by a physician (ie, via medical history and physical examination), other than a diagnosis of type 2 diabetes mellitus.
  • Has fasting clinical laboratory evaluations within the normal reference range for the testing laboratory, or if not, the results must be deemed not clinically significant by the investigator prior to Randomization.
  • Females must be post menopausal, surgically sterile, or using adequate contraception.

Exclusion Criteria:

  • Has been diagnosed with type 1 diabetes mellitus, hemochromatosis, or has a history of ketoacidosis.
  • Has any condition known to invalidate glycosylated hemoglobin results (eg, hemolytic states, hemoglobinopathies).
  • Is required to take or intends to continue taking any disallowed medication, any prescription medication, herbal treatment or over-the counter medication that may interfere with evaluation of the study medication, including:

    • Insulin
    • Oral anti-diabetics other than TAK-559 (including sulfonylureas other than glyburide, alpha-glucosidase inhibitors, metformin)
    • Systemic corticosteroids
    • Warfarin
    • Rifampin
    • St. John's Wort.
    • Thiazolidinediones
    • Peroxisome proliferator-activated receptor agonists
    • Nicotinic Acid
    • Fibrates
  • Has a history of myocardial infarction, coronary angioplasty or bypass graft, unstable angina pectoris, transient ischemic attacks, clinically significant abnormal electrocardiogram, or documented cerebrovascular accident within 6 months prior to Screening A.
  • Has had abdominal, thoracic, or vascular surgery within 6 months prior to Screening A that in the investigator's opinion would warrant exclusion from the study.
  • Has a creatine phosphokinase value greater than 3 times the upper limit of normal at Screening A. The creatine phosphokinase value can be retested prior to Randomization if elevated.
  • Has had persistent unexplained microscopic or macroscopic hematuria or a history of bladder cancer.
  • Has a triglyceride level greater than 500 mg/dL (5.6 mmol/L) at Screening A.
  • Has had any alteration in allowed lipid lowering medication (dose or drug) within 2 months of Randomization, if applicable.
  • Has donated and/or received any blood or blood products within 3 months prior to Randomization.
  • Has a history of drug abuse (defined as illicit drug use) or a history of alcohol abuse (defined as regular or daily consumption of more than 4 alcoholic drinks per day) within 2 years prior to Randomization.
  • Has a systolic BP greater than 140 mm Hg or a diastolic blood pressure of greater than 95 mm Hg at Screening B.
  • Has significant cardiovascular disease including but not limited to, New York Heart Association Functional (Cardiac) Classification III or IV.
  • Has a previous history of cancer, other than basal cell or stage 1 squamous cell carcinoma of the skin, that has not been in remission within 5 years prior to Randomization.
  • Has an alanine transaminase or aspartate transaminase level greater than 3 times the upper limit of normal, active liver disease, or jaundice at Screening A.
  • Has a positive human immunodeficiency virus, hepatitis B surface antigen, or hepatitis B e antigen test at Screening A.
  • Has any other serious disease or condition at Screening A or at Randomization that might affect life expectancy or make it difficult to successfully manage and follow the patient according to the protocol.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm Type

    Experimental

    Experimental

    Active Comparator

    Arm Label

    TAK-559 16 mg QD + Glyburide QD

    TAK-559 32 mg QD + Glyburide QD

    Glyburide QD

    Arm Description

    Outcomes

    Primary Outcome Measures

    Change from Baseline in Glycosylated hemoglobin level.

    Secondary Outcome Measures

    Change from baseline in Glycosylated hemoglobin level.
    Change from baseline in Fasting plasma glucose.
    Change from Baseline in Serum insulin.
    Change from Baseline in C-peptide.
    Change from Baseline in Lipids (triglyceride, total cholesterol, high-density lipoprotein, low-density lipoprotein and very low-density lipoproteins)
    Change from Baseline in Apolipoproteins [A1 and B]).
    Change from Baseline in Free fatty acids.
    Markers of thrombosis (plasminogen activator inhibitor-1 and fibrinogen).
    Markers of inflammation (interleukin-6 and C-reactive protein).
    Urinary albumin/creatinine ratio.
    Low-density lipoprotein fractionation [L-DL particles (total), intermediate-density lipoprotein, large L-DL, small L-DL (total), medium-small L-DL, very-small L-DL, mean L-DL size].

    Full Information

    First Posted
    September 24, 2008
    Last Updated
    February 1, 2012
    Sponsor
    Takeda
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    1. Study Identification

    Unique Protocol Identification Number
    NCT00759720
    Brief Title
    Efficacy and Safety of TAK-559 Combined With Glyburide in Treating Subjects With Type 2 Diabetes Mellitus.
    Acronym
    ORIGAMI
    Official Title
    A Multicenter, Double-Blind, Randomized, Placebo-Controlled, Parallel Study of the Safety and Efficacy of a Combination of TAK-559 and Glyburide Compared to Placebo and Glyburide in the Treatment of Patients With Type 2 Diabetes Mellitus
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    February 2012
    Overall Recruitment Status
    Terminated
    Why Stopped
    Potential hepatic safety signal
    Study Start Date
    November 2003 (undefined)
    Primary Completion Date
    December 2004 (Actual)
    Study Completion Date
    December 2004 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Takeda

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    The purpose of this study is to determine the safety and efficacy of TAK-559, once daily (QD), combined with glyburide in treating Type 2 Diabetes.
    Detailed Description
    Insulin is a primary regulator of blood glucose concentrations. A subnormal response to circulating insulin levels at target tissues leads to a decrease in insulin-mediated glucose uptake. Insulin resistance is associated with normal to high insulin levels and is often accompanied by dyslipidemia, a disruption in lipid metabolism resulting in increased triglycerides and low-density lipoprotein levels as well as decreased high-density lipoprotein levels in patients with type 2 diabetes mellitus. In the early stages of insulin resistance, a compensatory mechanism of increased insulin secretion by the pancreas maintains normal to near-normal glucose levels. Once the pancreas fails to maintain the increased insulin output, overt type 2 diabetes mellitus occurs. Insulin also plays an important role in the metabolism of fat and proteins and exerts its influence at the peroxisome proliferator-activated receptor level. Peroxisome proliferator-activated receptor -alpha receptors are expressed predominantly in skeletal muscle, adipose tissue, heart, liver, kidney, gut, macrophages, and vascular tissue, and play a key role in energy storage, glucose homeostasis, and vascular biology. Thus, as insulin activates peroxisome proliferator-activated receptor-alpha receptors, this results in the cellular uptake of glucose. Peroxisome proliferator-activated receptor receptors are ligand-activated transcription elements that regulate gene expression necessary for metabolism. For this reason, peroxisome proliferator-activated receptors play a pivotal role in glucose homeostasis, adipocyte differentiation, and lipid storage. The genes predominantly targeted by transcription activity of activated peroxisome proliferator-activated receptor-alpha receptors are those that mediate fatty acid uptake, fatty acid oxidation, and lipoprotein metabolism. As such, peroxisome proliferator-activated receptor-alpha agonists have their greatest effect on lipid metabolism and vascular biology. TAK-559 is a novel oxyiminoalkanoic acid under investigation for use as an oral agent in the treatment of patients with type 2 diabetes mellitus. TAK-559 has partial peroxisome proliferator-activated receptor-alpha agonist activity, potent peroxisome proliferator-activated receptor-alpha activity, and modest peroxisome proliferator-activated receptor-gamma activity at high concentrations in nonclinical models. This study was designed to evaluate the glycemic control and safety of TAK-559 in patients with type 2 diabetes mellitus taking glyburide for whom monotherapy with an oral anti-diabetics had been insufficient.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Diabetes Mellitus
    Keywords
    Glucose Metabolism Disorder, Dysmetabolic Syndrome, Type II Diabetes, Diabetes Mellitus, Lipoatrophic, Dyslipidemia, Drug Therapy

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 3
    Interventional Study Model
    Parallel Assignment
    Masking
    ParticipantCare ProviderInvestigatorOutcomes Assessor
    Allocation
    Randomized
    Enrollment
    447 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    TAK-559 16 mg QD + Glyburide QD
    Arm Type
    Experimental
    Arm Title
    TAK-559 32 mg QD + Glyburide QD
    Arm Type
    Experimental
    Arm Title
    Glyburide QD
    Arm Type
    Active Comparator
    Intervention Type
    Drug
    Intervention Name(s)
    TAK-559 and glyburide
    Other Intervention Name(s)
    Glibenclamide, Diabeta, Glynase, Micronase, Daonil, Semi-Daonil, Euglucon
    Intervention Description
    TAK-559 16 mg, tablets, orally, once daily and glyburide stable dose orally, once daily for up to 26 weeks.
    Intervention Type
    Drug
    Intervention Name(s)
    TAK-559 and glyburide
    Other Intervention Name(s)
    Glibenclamide, Diabeta, Glynase, Micronase, Daonil, Semi-Daonil, Euglucon
    Intervention Description
    TAK-559 32 mg, tablets, orally, once daily and glyburide stable dose, orally, once daily for up to 26 weeks.
    Intervention Type
    Drug
    Intervention Name(s)
    Glyburide
    Other Intervention Name(s)
    Glibenclamide, Diabeta, Glynase, Micronase, Daonil, Semi-Daonil, Euglucon
    Intervention Description
    TAK-559 placebo-matching tablets, orally, once daily and glyburide stable dose, orally, once daily for up to 26 weeks.
    Primary Outcome Measure Information:
    Title
    Change from Baseline in Glycosylated hemoglobin level.
    Time Frame
    Final Visit
    Secondary Outcome Measure Information:
    Title
    Change from baseline in Glycosylated hemoglobin level.
    Time Frame
    Weeks: 4, 8, 12, 16 and 20.
    Title
    Change from baseline in Fasting plasma glucose.
    Time Frame
    At all Visits.
    Title
    Change from Baseline in Serum insulin.
    Time Frame
    Weeks: 4, 12, 16, 20 and Final Visit.
    Title
    Change from Baseline in C-peptide.
    Time Frame
    Weeks: 4, 12, 16, 20 and Final Visit.
    Title
    Change from Baseline in Lipids (triglyceride, total cholesterol, high-density lipoprotein, low-density lipoprotein and very low-density lipoproteins)
    Time Frame
    Weeks: 12, 16, 20 and Final Visit.
    Title
    Change from Baseline in Apolipoproteins [A1 and B]).
    Time Frame
    Final Visit
    Title
    Change from Baseline in Free fatty acids.
    Time Frame
    Weeks: 12, 16, 20 and Final Visit.
    Title
    Markers of thrombosis (plasminogen activator inhibitor-1 and fibrinogen).
    Time Frame
    Weeks: 4, 12, 16, 20 and Final Visit.
    Title
    Markers of inflammation (interleukin-6 and C-reactive protein).
    Time Frame
    Weeks: 4, 12, 16, 20 and Final Visit.
    Title
    Urinary albumin/creatinine ratio.
    Time Frame
    Weeks: 4, 12, 16, 20 and Final Visit.
    Title
    Low-density lipoprotein fractionation [L-DL particles (total), intermediate-density lipoprotein, large L-DL, small L-DL (total), medium-small L-DL, very-small L-DL, mean L-DL size].
    Time Frame
    Weeks 12, 16, 20, and Final Visit

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    25 Years
    Maximum Age & Unit of Time
    75 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Must be diagnosed with type 2 diabetes mellitus using American Diabetes Association diagnostic criteria, and on a stable dose of an oral anti-diabetic monotherapy prior to Screening A. Has a glycosylated hemoglobin level greater than or equal to 8.0% and less than or equal to 10.0% at Screening B. Has a fasting plasma glucose greater than or equal to 126 mg/dL (7.0 mmol/L) at Screening B. Is taking a stable dose of at least 10 mg of glyburide for at least 10 days prior to Screening B. Has a stable or worsening self-monitoring blood glucose level while taking glyburide. The patient must have a low-density lipoprotein less than 160 mg/dL (4.1 mmol/L) at Screening A. Has a body mass index less than or equal to 45 kg/m2 at Screening A. Is willing to be counseled by the investigator or designee to follow an individualized, weight-maintaining diet during the study period. Has evidence of insulin secretory capacity as demonstrated by a C-peptide concentration of greater than or equal to 1.5 ng/mL (0.50 nmol/L) at Screening A, and if necessary, after a repeat at Screening B. The patient must be able to perform daily self-monitoring blood glucose tests throughout the study. Has a normal thyroid-stimulating hormone level of less than 5.5 uIU/mL (5.5 mIU/L) and greater than or equal to 0.35 uIU/mL (0.35 mIU/L) at Screening A. Is in good health as determined by a physician (ie, via medical history and physical examination), other than a diagnosis of type 2 diabetes mellitus. Has fasting clinical laboratory evaluations within the normal reference range for the testing laboratory, or if not, the results must be deemed not clinically significant by the investigator prior to Randomization. Females must be post menopausal, surgically sterile, or using adequate contraception. Exclusion Criteria: Has been diagnosed with type 1 diabetes mellitus, hemochromatosis, or has a history of ketoacidosis. Has any condition known to invalidate glycosylated hemoglobin results (eg, hemolytic states, hemoglobinopathies). Is required to take or intends to continue taking any disallowed medication, any prescription medication, herbal treatment or over-the counter medication that may interfere with evaluation of the study medication, including: Insulin Oral anti-diabetics other than TAK-559 (including sulfonylureas other than glyburide, alpha-glucosidase inhibitors, metformin) Systemic corticosteroids Warfarin Rifampin St. John's Wort. Thiazolidinediones Peroxisome proliferator-activated receptor agonists Nicotinic Acid Fibrates Has a history of myocardial infarction, coronary angioplasty or bypass graft, unstable angina pectoris, transient ischemic attacks, clinically significant abnormal electrocardiogram, or documented cerebrovascular accident within 6 months prior to Screening A. Has had abdominal, thoracic, or vascular surgery within 6 months prior to Screening A that in the investigator's opinion would warrant exclusion from the study. Has a creatine phosphokinase value greater than 3 times the upper limit of normal at Screening A. The creatine phosphokinase value can be retested prior to Randomization if elevated. Has had persistent unexplained microscopic or macroscopic hematuria or a history of bladder cancer. Has a triglyceride level greater than 500 mg/dL (5.6 mmol/L) at Screening A. Has had any alteration in allowed lipid lowering medication (dose or drug) within 2 months of Randomization, if applicable. Has donated and/or received any blood or blood products within 3 months prior to Randomization. Has a history of drug abuse (defined as illicit drug use) or a history of alcohol abuse (defined as regular or daily consumption of more than 4 alcoholic drinks per day) within 2 years prior to Randomization. Has a systolic BP greater than 140 mm Hg or a diastolic blood pressure of greater than 95 mm Hg at Screening B. Has significant cardiovascular disease including but not limited to, New York Heart Association Functional (Cardiac) Classification III or IV. Has a previous history of cancer, other than basal cell or stage 1 squamous cell carcinoma of the skin, that has not been in remission within 5 years prior to Randomization. Has an alanine transaminase or aspartate transaminase level greater than 3 times the upper limit of normal, active liver disease, or jaundice at Screening A. Has a positive human immunodeficiency virus, hepatitis B surface antigen, or hepatitis B e antigen test at Screening A. Has any other serious disease or condition at Screening A or at Randomization that might affect life expectancy or make it difficult to successfully manage and follow the patient according to the protocol.
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Sr VP Clinical Research
    Organizational Affiliation
    Takeda
    Official's Role
    Study Director

    12. IPD Sharing Statement

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    Efficacy and Safety of TAK-559 Combined With Glyburide in Treating Subjects With Type 2 Diabetes Mellitus.

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