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This study evaluated how a single dose of delayed-release metformin (Met DR) behaves in subjects with normal kidney function, mild kidney dysfunction, moderate kidney dysfunction, or severe kidney dysfunction. The safety and tolerability of Met DR was also examined. In addition, this study compared the behavior of a single dose of Met DR with that of extended-release metformin (Met XR) and placebo in subjects with the varying levels of kidney function described above.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Met DR | Experimental | One dose of 1000 mg metformin delayed-release |
|
| Met XR | Active Comparator | One dose of 1000 mg metformin extended-release |
|
| Placebo | Placebo Comparator | One dose of Placebo |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Met DR | Drug | metformin delayed-release tablets |
| |
| Met XR |
| Measure | Description | Time Frame |
|---|---|---|
| AUC (0-t) of Plasma Metformin | AUC (0-t) = Area under the curve from the time of dosing (0 h) to the time of the last quantifiable concentration following dose administration | from the time of dosing (0 h) to 72 hours postdose |
| Cmax of Plasma Metformin | Cmax = Maximum concentration from the time of dosing (0 h) to the time of the last quantifiable metformin concentration following dose administration | from the time of dosing (0 h) to 72 hours postdose |
| Correlation of Placebo-adjusted Change From Pre-dose Value in Lactate Versus Metformin Concentration | To determine the exposure-response relationship of metformin and plasma lactate concentrations | from the time of dosing (0 h) to 24 hours postdose |
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Inclusion Criteria:
18 to 80 (inclusive) years old at Visit 1 (Screening)
Male, or female and met all of the following criteria:
Body mass index (BMI) of 18.0 to 40.0 kg/m² (inclusive) at Visit 1 (Screening)
Had type 2 diabetes mellitus and an HbA1c ≤10.0%
Had a physical examination with no clinically significant abnormalities as judged by the investigator
Estimated glomerular filtration rate (eGFR) ≥15 mL/min/1.73 m² based on the Modification of Diet in Renal Disease (MDRD) equation
Ability to understand and willingness to adhere to protocol requirements
Exclusion Criteria:
Had End Stage Renal Disease requiring dialysis or severe renal dysfunction with eGFR <15 mL/min/1.73 m²
Was on dialysis or had been on dialysis within 12 months of Visit 1 (Screening)
Had received or planned to receive any iodinated contrast dye within 1 week prior to Visit 1 (Screening) or after study medication administration
Was taking or had taken within 1 week of Visit 1 cationic drugs that are eliminated by renal tubular secretion (e.g., amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim, and vancomycin)
Had a clinically significant medical condition that could potentially affect study participation and/or personal well-being, as judged by the investigator, including but not limited to the following conditions:
Had any chronic disease requiring medication that had been adjusted in the past 14 days (subjects could take acute intermittent over-the-counter medications such as Tylenol, if needed)
Had major surgery of any kind within 6 months of Visit 1 (Screening)
Had a clinically significant finding of an electrocardiogram (ECG) as assessed by the investigator at Visit 1 (Screening)
Had clinical laboratory test (clinical chemistry, hematology, or urinalysis) abnormalities, other than those related to diabetes or renal disease and other stable diseases, judged by the investigator to be clinically significant at Visit 1 (Screening)
Had a hemoglobin result <8 g/dL or a level indicating severe anemia of renal origin
Had a physical, psychological, or historical finding that, in the investigator's opinion, would make the subject unsuitable for the study
Had received Byetta® or short-acting insulin within 3 days of Visit 1 (Screening)
Had received metformin within 4 weeks of Visit 1 (Screening)
Had any drug treatment that affects gastrointestinal motility or gastric pH (prescription or over-the-counter), including any antacids or medications such as Rolaids or Pepcid, within 2 days of Visit 2
Abused drugs or alcohol or had a history of abuse that in the investigator's opinion would cause the individual to be noncompliant with study procedures
Smoked more than 10 cigarettes, 3 cigars, or 3 pipes per day
Had donated blood within 2 months of Visit 1 (Screening) or was planning to donate blood during the study
Had received any investigational drug within one month (or seven half-lives of the investigational drug, whichever was greater) of Visit 1 (Screening)
Had known allergies or hypersensitivity to any component of study treatment
Was employed by Elcelyx Therapeutics, Inc (that is an employee, temporary contract worker, or designee of the company)
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| Name | Affiliation | Role |
|---|---|---|
| George Canas, MD | Prism Research | Principal Investigator |
| Kenneth Lasseter, MD | Clinical Pharmacology of Miami, Inc | Principal Investigator |
| Alexander White, MD | Progressive Medical Research | Principal Investigator |
| Harold Bays, MD | Louisville Metabolic and Atherosclerosis Research Center | Principal Investigator |
| Craig Curtis, MD | Compass Research | Principal Investigator |
| Prabir Roy-Chaudhury | Cincinnati Veterans Affairs Medical Center Department of Internal Medicine | Principal Investigator |
| Sunder Mudaliar | San Diego Veterans Healthcare System | Principal Investigator |
| Nelson Kopyt | Northeast Clinical Research Center | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Result | Bakris GL, Mudaliar, S, Kim T, Burns C, Skare S, Baron A, Fineman M. Effects of New Metformin Formulation in Stage 3 and 4 CKD: A Pilot Study. J Am Soc Nephrol. 2014; 25:549A. | ||
| 26773926 | Result | DeFronzo R, Fleming GA, Chen K, Bicsak TA. Metformin-associated lactic acidosis: Current perspectives on causes and risk. Metabolism. 2016 Feb;65(2):20-9. doi: 10.1016/j.metabol.2015.10.014. Epub 2015 Oct 9. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Sequence ABC | A = 1 dose of 1000 mg Met XR B = 1 dose of 1000 mg Met DR C = 1 dose of placebo each treatment was separated by a wash out period of 2 to 10 days |
| FG001 | Sequence CAB | A = 1 dose of 1000 mg Met XR B = 1 dose of 1000 mg Met DR C = 1 dose of placebo each treatment was separated by a wash out period of 2 to 10 days |
| FG002 | Sequence BCA | A = 1 dose of 1000 mg Met XR B = 1 dose of 1000 mg Met DR C = 1 dose of placebo each treatment was separated by a wash out period of 2 to 10 days |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
Randomized Population - All subjects were to receive all interventions and are distributed in this module according to their renal function cohort to inform PK analyses comparing these populations
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| ID | Title | Description |
|---|---|---|
| BG000 | Normal | Normal Renal Function = eGFR ≥90 mL/min/1.73 m² |
| BG001 | Mild RI | Mild Renal Impairment = eGFR ≥60 to <90 mL/min/1.73 m² |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | AUC (0-t) of Plasma Metformin | AUC (0-t) = Area under the curve from the time of dosing (0 h) to the time of the last quantifiable concentration following dose administration | PK Evaluable Population | Posted | Least Squares Mean | Standard Error | ng*h/mL | from the time of dosing (0 h) to 72 hours postdose |
|
Approximately 19 to 76 days depending on the number of days before the start of Visits 2 and 3 and the number of washout days between the treatment visits.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Placebo | One dose of Placebo |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Diarrhoea | Gastrointestinal disorders |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Senior Director, Development | Elcelyx Therapeutics, Inc | 858-876-1814 | info@elcelyx.com |
| ID | Term |
|---|---|
| D051437 | Renal Insufficiency |
| ID | Term |
|---|---|
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
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| Drug |
metformin extended-release tablets |
|
| Placebo | Drug |
|
| BG002 | Moderate RI | Moderate Renal Impairment = eGFR ≥30 to <60 mL/min/1.73 m² |
| BG003 | Severe RI | Severe Renal Impairment = eGFR ≥15 to <30 mL/min/1.73 m² |
| BG004 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Body Weight | Mean | Standard Deviation | kg |
|
| BMI | Mean | Standard Deviation | kg/m² |
|
| Units | Counts |
|---|
| Participants |
|
|
|
| Primary | Cmax of Plasma Metformin | Cmax = Maximum concentration from the time of dosing (0 h) to the time of the last quantifiable metformin concentration following dose administration | PK Evaluable Population | Posted | Least Squares Mean | Standard Error | ng/mL | from the time of dosing (0 h) to 72 hours postdose |
|
|
|
|
| Primary | Correlation of Placebo-adjusted Change From Pre-dose Value in Lactate Versus Metformin Concentration | To determine the exposure-response relationship of metformin and plasma lactate concentrations | PD Evaluable Population | Posted | Number | R² | from the time of dosing (0 h) to 24 hours postdose |
|
|
|
|
| 0 |
| 36 |
| 4 |
| 36 |
| EG001 | Met DR | One dose of 1000 mg Metformin Delayed-Release | 0 | 38 | 12 | 38 |
| EG002 | Met XR | One dose of 1000 mg Metformin Extended-Release | 0 | 37 | 11 | 37 |
| Vessel Puncture Site Haemorrhage | General disorders |
|
| Hyperglycaemia | Metabolism and nutrition disorders |
|
| Dizziness | Nervous system disorders |
|
| Dyspepsia | Gastrointestinal disorders |
|
| Nausea | Gastrointestinal disorders |
|
| Abdominal Distension | Gastrointestinal disorders |
|
| Constipation | Gastrointestinal disorders |
|
| Food Poisoning | Gastrointestinal disorders |
|
| Gastrooesophageal Reflux Disease | Gastrointestinal disorders |
|
| Toothache | Gastrointestinal disorders |
|
| Vomiting | Gastrointestinal disorders |
|
| Fatigue | General disorders |
|
| Infusion Site Haemorrhage | General disorders |
|
| Oedema Peripheral | General disorders |
|
| Pyrexia | General disorders |
|
| Vessel Puncture Site Pain | General disorders |
|
| Vessel Puncture Site Reaction | General disorders |
|
| Gout | Metabolism and nutrition disorders |
|
| Hypoglycaemia | Metabolism and nutrition disorders |
|
| Headache | Nervous system disorders |
|
| Nasopharyngitis | Infections and infestations |
|
| Upper Respiratory Tract Infection | Infections and infestations |
|
| Blood Creatine Phosphokinase Increased | Investigations |
|
| Flank Pain | Musculoskeletal and connective tissue disorders |
|
| Pollakiuria | Renal and urinary disorders |
|
| Throat Tightness | Respiratory, thoracic and mediastinal disorders |
|
The results of the Study may be published by INSTITUTE, however the publication shall not disclose any SPONSOR Confidential Information, the INSTITUTE shall send the SPONSOR a copy of any such proposed publication 90 days prior to submission for publication, the INSTITUTE, on request of the SPONSOR, shall delete any SPONSOR Confidential Information in the proposed publication, and the INSTITUTE shall, on the SPONSOR's request, delay submission while the SPONSOR files applications for patents.
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
| Moderate RI (N = 9) |
|
| Severe RI (N = 7) |
|
| For the Mild RI Renal Function Cohort. Met XR is the denominator for the % ratio of LS means and the comparator for the p-values. | ANOVA | Included treatment, renal group, sequence, period and treatment*renal group as fixed effects and subject nested within sequence as a random effect. | 0.1691 | p-values <0.10 are considered statistically significant | % Ratio of LS Means | 77.3 | 2-Sided | 90 | 56.72 | 105.41 | No | Superiority or Other |
| For the Moderate RI Renal Function Cohort. Met XR is the denominator for the % ratio of LS means and the comparator for the p-values. | ANOVA | Included treatment, renal group, sequence, period and treatment*renal group as fixed effects and subject nested within sequence as a random effect. | 0.0064 | p-values <0.10 are considered statistically significant | % Ratio of LS Means | 56.6 | 2-Sided | 90 | 40.73 | 78.63 | No | Superiority or Other |
| For the Severe RI Renal Function Cohort. Met XR is the denominator for the % ratio of LS means and the comparator for the p-values. | ANOVA | Included treatment, renal group, sequence, period and treatment*renal group as fixed effects and subject nested within sequence as a random effect. | 0.0097 | p-values <0.10 are considered statistically significant | % Ratio of LS Means | 54.6 | 2-Sided | 90 | 37.68 | 79.11 | No | Superiority or Other |
| <0.0001 |
R² for placebo-adjusted change from pre-dose value in lactate versus metformin concentration |
| 2-Sided |
| No |
| Superiority or Other |