Saxagliptin plus metformin beats uptitrated metformin in glycemic control
MedWire News: Saxagliptin added to metformin extended-release (XR) is superior to uptitrated metformin XR in improving glycemic control in patients with Type 2 diabetes, show US researchers.
The addition of saxagliptin 5 mg to metformin XR 1500 mg/day resulted in significantly greater improvements in glycated hemoglobin (HbA1c), 120-min postprandial glucose (PPG), and fasting plasma glucose (FPG) than increasing the dose of metformin XR to 2000 mg/day (the maximal recommended dose).
"The benefits of uptitration versus adding another agent are questionable because, as Type 2 diabetes progresses, most patients will require combination therapy to maintain glycemic control," say Vivian Fonseca (Tulane University Health Sciences Center, New Orleans) and colleagues.
"An alternate strategy is the earlier introduction of combination therapy," they suggest.
As reported in Diabetes, Obesity and Metabolism, the researchers recruited 249 Type 2 diabetes patients who had inadequate glycemic control (HbA1c 7.5-11.0%) after at least 8 weeks of daily treatment with metformin (850-1500 mg/day).
The team stabilized the participants on a daily dose of metformin XR 1500 mg during an 8-week lead-in period. They then randomly assigned the patients to take saxagliptin 5 mg/day plus metformin XR 1500 mg/day or an uptitrated metformin XR dosage of 2000 mg/day for a period of 18 weeks.
The team found that, at week 18, the mean reduction from baseline HbA1c was 0.88% for saxagliptin plus metformin XR compared with 0.35% for uptitrated metformin XR.
Patients taking saxagliptin plus metformin XR also had significantly greater reductions in mean 120-min PPG and FPG levels than those receiving uptitrated metformin XR, of 1.3 and 0.73 mmol/L, respectively.
In addition, the proportion of patients achieving an HbA1c level of less than 7.0% was significantly greater in the saxagliptin plus metformin XR group than it was in the uptitrated metformin XR group at 37.3% versus 26.1%.
Furthermore, the proportion of patients experiencing any adverse events was similar between the groups, with no additional safety concerns found with the saxagliptin plus metformin XR group compared with the uptitrated metformin XR group.
"Earlier use of combination therapy may, therefore, be a more appropriate treatment option for Type 2 diabetes patients with inadequate glycemic control on monotherapy than uptitrating metformin to the maximal recommended dose," conclude Fonseca et al.
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By Sally Robertson