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Published in: Advances in Therapy 3/2021

01-03-2021 | Insulins | Original Research

Benefit of Early Add-on of Linagliptin to Insulin in Japanese Patients With Type 2 Diabetes Mellitus: Randomized-Controlled Open-Label Trial (TRUST2)

Authors: Tomoyuki Katsuno, Toshihiko Shiraiwa, Shingo Iwasaki, Hyohun Park, Nobuaki Watanabe, Shizuka Kaneko, Jungo Terasaki, Toshiaki Hanafusa, Akihisa Imagawa, Iichiro Shimomura, Hiroshi Ikegami, Hidenori Koyama, Mitsuyoshi Namba, Jun-ichiro Miyagawa, For the TRUST2 study group

Published in: Advances in Therapy | Issue 3/2021

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Abstract

Introduction

This trial was conducted to assess the long-term safety, efficacy, and benefit of early add-on of linagliptin to insulin in patients with type 2 diabetes mellitus (T2DM).

Methods

This trial enrolled 246 subjects. The subjects were randomized to the linagliptin group or the control group and were observed for 156 weeks. After week 16, subjects in the control group were also allowed to add linagliptin to evaluate the benefit of early add-on of linagliptin to insulin. The primary end point was a change in HbA1c from baseline to week 16. Secondary end points included fasting plasma glucose, daily insulin dose, and frequency of adverse events.

Results

HbA1c and fasting plasma glucose levels significantly decreased from baseline to week 16 in the linagliptin group compared with the control group. The significant improvement in HbA1c continued until week 52. The daily insulin dose significantly decreased in the linagliptin group compared with the control group. The frequency of hypoglycemia and adverse events was comparable in both groups.

Conclusions

Add-on of linagliptin to insulin was tolerated, improved glycemic control, and reduced the daily insulin dose. This study demonstrates the long-term safety, efficacy and benefit of early add-on of linagliptin to insulin in Japanese T2DM patients.
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Literature
1.
go back to reference Seino Y, Kuwata H, Yabe D. Incretin-based drugs for type 2 diabetes: focus on East Asian perspectives. J Diabetes Investig. 2016;1:102–9.CrossRef Seino Y, Kuwata H, Yabe D. Incretin-based drugs for type 2 diabetes: focus on East Asian perspectives. J Diabetes Investig. 2016;1:102–9.CrossRef
2.
go back to reference Kim YG, Hahn S, Oh TJ, Kwak SH, Park KS, Cho YM. Differences in the glucose-lowering efficacy of dipeptidyl peptidase-4 inhibitors between Asians and non-Asians: a systematic review and meta-analysis. Diabetologia. 2013;56:696–708.CrossRef Kim YG, Hahn S, Oh TJ, Kwak SH, Park KS, Cho YM. Differences in the glucose-lowering efficacy of dipeptidyl peptidase-4 inhibitors between Asians and non-Asians: a systematic review and meta-analysis. Diabetologia. 2013;56:696–708.CrossRef
3.
go back to reference Ahren B. Dipeptidyl peptidase-4 inhibitors: clinical data and clinical implications. Diabetes Care. 2007;30:1344–50.CrossRef Ahren B. Dipeptidyl peptidase-4 inhibitors: clinical data and clinical implications. Diabetes Care. 2007;30:1344–50.CrossRef
5.
go back to reference Green JB, Bethel MA, Armstrong PW, et al. Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2015;373:232–42.CrossRef Green JB, Bethel MA, Armstrong PW, et al. Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2015;373:232–42.CrossRef
6.
go back to reference White WB, Cannon CP, Heller SR, et al. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med. 2013;369:1327–35.CrossRef White WB, Cannon CP, Heller SR, et al. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med. 2013;369:1327–35.CrossRef
7.
go back to reference Scirica BM, Bhatt DL, Braunwald E, et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013;369:1317–26.CrossRef Scirica BM, Bhatt DL, Braunwald E, et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013;369:1317–26.CrossRef
8.
go back to reference Rosenstock J, Perkovic V, Johansen OE, et al. Effect of linagliptin vs placebo on major cardiovascular events in adults with type 2 diabetes and high cardiovascular and renal risk: the CARMELINA randomized clinical trial. JAMA. 2019;321:69–79.CrossRef Rosenstock J, Perkovic V, Johansen OE, et al. Effect of linagliptin vs placebo on major cardiovascular events in adults with type 2 diabetes and high cardiovascular and renal risk: the CARMELINA randomized clinical trial. JAMA. 2019;321:69–79.CrossRef
9.
go back to reference Kadowaki T, Wang G, Rosenstock J, et al. Effect of linagliptin, a dipeptidyl peptidase-4 inhibitor, compared with the sulfonylurea glimepiride on cardiovascular outcomes in Asians with type 2 diabetes: subgroup analysis of the randomized CAROLINA trial. Diabetol Int. 2020;2:2. Kadowaki T, Wang G, Rosenstock J, et al. Effect of linagliptin, a dipeptidyl peptidase-4 inhibitor, compared with the sulfonylurea glimepiride on cardiovascular outcomes in Asians with type 2 diabetes: subgroup analysis of the randomized CAROLINA trial. Diabetol Int. 2020;2:2.
10.
go back to reference Inagaki N, Yang W, Watada H, et al. Linagliptin and cardiorenal outcomes in Asians with type 2 diabetes mellitus and established cardiovascular and/or kidney disease: subgroup analysis of the randomized CARMELINA trial. Diabetol Int. 2020;11:129–41.CrossRef Inagaki N, Yang W, Watada H, et al. Linagliptin and cardiorenal outcomes in Asians with type 2 diabetes mellitus and established cardiovascular and/or kidney disease: subgroup analysis of the randomized CARMELINA trial. Diabetol Int. 2020;11:129–41.CrossRef
11.
go back to reference Mita T, Katakami N, Shiraiwa T, et al. Sitagliptin attenuates the progression of carotid intima-media thickening in insulin-treated patients with type 2 diabetes: the Sitagliptin preventive study of intima-media thickness evaluation (SPIKE): a randomized controlled trial. Diabetes Care. 2016;39:455–64.CrossRef Mita T, Katakami N, Shiraiwa T, et al. Sitagliptin attenuates the progression of carotid intima-media thickening in insulin-treated patients with type 2 diabetes: the Sitagliptin preventive study of intima-media thickness evaluation (SPIKE): a randomized controlled trial. Diabetes Care. 2016;39:455–64.CrossRef
12.
go back to reference Mita T, Katakami N, Yoshii H, et al. Alogliptin, a dipeptidyl peptidase 4 inhibitor, prevents the progression of carotid atherosclerosis in patients with type 2 diabetes: the study of preventive effects of alogliptin on diabetic atherosclerosis (SPEAD-A). Diabetes Care. 2016;39:139–48.CrossRef Mita T, Katakami N, Yoshii H, et al. Alogliptin, a dipeptidyl peptidase 4 inhibitor, prevents the progression of carotid atherosclerosis in patients with type 2 diabetes: the study of preventive effects of alogliptin on diabetic atherosclerosis (SPEAD-A). Diabetes Care. 2016;39:139–48.CrossRef
13.
go back to reference Hong D, Si L, Jiang M, et al. Cost effectiveness of sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase-4 (DPP-4) inhibitors: a systematic review. Pharmacoeconomics. 2019;37:777–818.CrossRef Hong D, Si L, Jiang M, et al. Cost effectiveness of sodium-glucose cotransporter-2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase-4 (DPP-4) inhibitors: a systematic review. Pharmacoeconomics. 2019;37:777–818.CrossRef
14.
go back to reference Geng J, Yu H, Mao Y, Zhang P, Chen Y. Cost effectiveness of dipeptidyl peptidase-4 inhibitors for type 2 diabetes. Pharmacoeconomics. 2015;33:581–97.CrossRef Geng J, Yu H, Mao Y, Zhang P, Chen Y. Cost effectiveness of dipeptidyl peptidase-4 inhibitors for type 2 diabetes. Pharmacoeconomics. 2015;33:581–97.CrossRef
15.
go back to reference Ledesma G, Umpierrez GE, Morley JE, et al. Efficacy and safety of linagliptin to improve glucose control in older people with type 2 diabetes on stable insulin therapy: a randomized trial. Diabetes Obes Metab. 2019;21:2465–73.CrossRef Ledesma G, Umpierrez GE, Morley JE, et al. Efficacy and safety of linagliptin to improve glucose control in older people with type 2 diabetes on stable insulin therapy: a randomized trial. Diabetes Obes Metab. 2019;21:2465–73.CrossRef
16.
go back to reference Zinman B, Ahren B, Neubacher D, Patel S, Woerle HJ, Johansen OE. Efficacy and cardiovascular safety of linagliptin as an add-on to insulin in type 2 diabetes: a pooled comprehensive post hoc analysis. Can J Diabetes. 2016;40:50–7.CrossRef Zinman B, Ahren B, Neubacher D, Patel S, Woerle HJ, Johansen OE. Efficacy and cardiovascular safety of linagliptin as an add-on to insulin in type 2 diabetes: a pooled comprehensive post hoc analysis. Can J Diabetes. 2016;40:50–7.CrossRef
17.
go back to reference Yki-Jarvinen H, Rosenstock J, Duran-Garcia S, et al. Effects of adding linagliptin to basal insulin regimen for inadequately controlled type 2 diabetes: a >/=52-week randomized, double-blind study. Diabetes Care. 2013;36:3875–81.CrossRef Yki-Jarvinen H, Rosenstock J, Duran-Garcia S, et al. Effects of adding linagliptin to basal insulin regimen for inadequately controlled type 2 diabetes: a >/=52-week randomized, double-blind study. Diabetes Care. 2013;36:3875–81.CrossRef
18.
go back to reference Vilsboll T, Rosenstock J, Yki-Jarvinen H, et al. Efficacy and safety of sitagliptin when added to insulin therapy in patients with type 2 diabetes. Diabetes Obes Metab. 2010;12:167–77.CrossRef Vilsboll T, Rosenstock J, Yki-Jarvinen H, et al. Efficacy and safety of sitagliptin when added to insulin therapy in patients with type 2 diabetes. Diabetes Obes Metab. 2010;12:167–77.CrossRef
19.
go back to reference Katsuno T, Ikeda H, Namba M. Medium-term effect of add-on therapy with the DPP-4 inhibitor, sitagliptin, in insulin-treated japanese patients with type 2 diabetes mellitus. Diabetes Ther. 2016;7:309–20.CrossRef Katsuno T, Ikeda H, Namba M. Medium-term effect of add-on therapy with the DPP-4 inhibitor, sitagliptin, in insulin-treated japanese patients with type 2 diabetes mellitus. Diabetes Ther. 2016;7:309–20.CrossRef
20.
go back to reference Katsuno T, Ikeda H, Ida K, Miyagawa J, Namba M. Add-on therapy with the DPP-4 inhibitor sitagliptin improves glycemic control in insulin-treated Japanese patients with type 2 diabetes mellitus. Endocr J. 2013;60:733–42.CrossRef Katsuno T, Ikeda H, Ida K, Miyagawa J, Namba M. Add-on therapy with the DPP-4 inhibitor sitagliptin improves glycemic control in insulin-treated Japanese patients with type 2 diabetes mellitus. Endocr J. 2013;60:733–42.CrossRef
21.
go back to reference Araki E, Unno Y, Tanaka Y, Sakamoto W, Miyamoto Y. Long-term efficacy and safety of linagliptin in a Japanese population with type 2 diabetes aged >/= 60 years treated with basal insulin: a randomised trial. Adv Ther. 2019;36:2697–711.CrossRef Araki E, Unno Y, Tanaka Y, Sakamoto W, Miyamoto Y. Long-term efficacy and safety of linagliptin in a Japanese population with type 2 diabetes aged >/= 60 years treated with basal insulin: a randomised trial. Adv Ther. 2019;36:2697–711.CrossRef
22.
go back to reference Graefe-Mody U, Friedrich C, Port A, et al. Effect of renal impairment on the pharmacokinetics of the dipeptidyl peptidase-4 inhibitor linagliptin(*). Diabetes Obes Metab. 2011;13:939–46.CrossRef Graefe-Mody U, Friedrich C, Port A, et al. Effect of renal impairment on the pharmacokinetics of the dipeptidyl peptidase-4 inhibitor linagliptin(*). Diabetes Obes Metab. 2011;13:939–46.CrossRef
23.
go back to reference von Websky K, Reichetzeder C, Hocher B. Linagliptin as add-on therapy to insulin for patients with type 2 diabetes. Vasc Health Risk Manag. 2013;9:681–94. von Websky K, Reichetzeder C, Hocher B. Linagliptin as add-on therapy to insulin for patients with type 2 diabetes. Vasc Health Risk Manag. 2013;9:681–94.
24.
go back to reference McGill JB, Sloan L, Newman J, et al. Long-term efficacy and safety of linagliptin in patients with type 2 diabetes and severe renal impairment: a 1-year, randomized, double-blind, placebo-controlled study. Diabetes Care. 2013;36:237–44.CrossRef McGill JB, Sloan L, Newman J, et al. Long-term efficacy and safety of linagliptin in patients with type 2 diabetes and severe renal impairment: a 1-year, randomized, double-blind, placebo-controlled study. Diabetes Care. 2013;36:237–44.CrossRef
25.
go back to reference Ishii H. Development and psychometric validation of the diabetes therapy-related QOL (DTR-QOL) questionnaire. J Med Econ. 2012;15:556–63.CrossRef Ishii H. Development and psychometric validation of the diabetes therapy-related QOL (DTR-QOL) questionnaire. J Med Econ. 2012;15:556–63.CrossRef
26.
go back to reference Ishii H, Kim HR, Crawford B. The revalidation of the diabetes treatment-related quality-of-life (DTR-QOL) questionnaire in Japan. Diabetol Int. 2019;10:93–101.CrossRef Ishii H, Kim HR, Crawford B. The revalidation of the diabetes treatment-related quality-of-life (DTR-QOL) questionnaire in Japan. Diabetol Int. 2019;10:93–101.CrossRef
27.
go back to reference Kawamori R, Inagaki N, Araki E, et al. Linagliptin monotherapy provides superior glycaemic control versus placebo or voglibose with comparable safety in Japanese patients with type 2 diabetes: a randomized, placebo and active comparator-controlled, double-blind study. Diabetes Obes Metab. 2012;14:348–57.CrossRef Kawamori R, Inagaki N, Araki E, et al. Linagliptin monotherapy provides superior glycaemic control versus placebo or voglibose with comparable safety in Japanese patients with type 2 diabetes: a randomized, placebo and active comparator-controlled, double-blind study. Diabetes Obes Metab. 2012;14:348–57.CrossRef
28.
go back to reference Gallwitz B, Rosenstock J, Rauch T, et al. 2-year efficacy and safety of linagliptin compared with glimepiride in patients with type 2 diabetes inadequately controlled on metformin: a randomised, double-blind, non-inferiority trial. Lancet. 2012;380:475–83.CrossRef Gallwitz B, Rosenstock J, Rauch T, et al. 2-year efficacy and safety of linagliptin compared with glimepiride in patients with type 2 diabetes inadequately controlled on metformin: a randomised, double-blind, non-inferiority trial. Lancet. 2012;380:475–83.CrossRef
29.
go back to reference Karagiannis T, Boura P, Tsapas A. Safety of dipeptidyl peptidase 4 inhibitors: a perspective review. Ther Adv Drug Saf. 2014;5:138–46.CrossRef Karagiannis T, Boura P, Tsapas A. Safety of dipeptidyl peptidase 4 inhibitors: a perspective review. Ther Adv Drug Saf. 2014;5:138–46.CrossRef
30.
go back to reference Rosenstock J, Kahn SE, Johansen OE, et al. Effect of Linagliptin vs glimepiride on major adverse cardiovascular outcomes in patients with type 2 diabetes: the CAROLINA randomized clinical trial. JAMA. 2019;322:2255–1166.CrossRef Rosenstock J, Kahn SE, Johansen OE, et al. Effect of Linagliptin vs glimepiride on major adverse cardiovascular outcomes in patients with type 2 diabetes: the CAROLINA randomized clinical trial. JAMA. 2019;322:2255–1166.CrossRef
31.
go back to reference Inzucchi SE, Nauck MA, Hehnke U, Woerle HJ, von Eynatten M, Henry RR. Improved glucose control with reduced hypoglycaemic risk when linagliptin is added to basal insulin in elderly patients with type 2 diabetes. Diabetes Obes Metab. 2015;17:868–77.CrossRef Inzucchi SE, Nauck MA, Hehnke U, Woerle HJ, von Eynatten M, Henry RR. Improved glucose control with reduced hypoglycaemic risk when linagliptin is added to basal insulin in elderly patients with type 2 diabetes. Diabetes Obes Metab. 2015;17:868–77.CrossRef
32.
go back to reference Lando HM, Alattar M, Dua AP. Elevated amylase and lipase levels in patients using glucagonlike peptide-1 receptor agonists or dipeptidyl-peptidase-4 inhibitors in the outpatient setting. Endocr Pract. 2012;18:472–7.CrossRef Lando HM, Alattar M, Dua AP. Elevated amylase and lipase levels in patients using glucagonlike peptide-1 receptor agonists or dipeptidyl-peptidase-4 inhibitors in the outpatient setting. Endocr Pract. 2012;18:472–7.CrossRef
33.
go back to reference Tokuyama H, Kawamura H, Fujimoto M, et al. A low-grade increase of serum pancreatic exocrine enzyme levels by dipeptidyl peptidase-4 inhibitor in patients with type 2 diabetes. Diabetes Res Clin Pract. 2013;100:e66.CrossRef Tokuyama H, Kawamura H, Fujimoto M, et al. A low-grade increase of serum pancreatic exocrine enzyme levels by dipeptidyl peptidase-4 inhibitor in patients with type 2 diabetes. Diabetes Res Clin Pract. 2013;100:e66.CrossRef
34.
go back to reference Mita T, Hiyoshi T, Yoshii H, et al. The effect of linagliptin versus metformin treatment-related quality of life in patients with type 2 diabetes mellitus. Diabetes Ther. 2019;10:119–34.CrossRef Mita T, Hiyoshi T, Yoshii H, et al. The effect of linagliptin versus metformin treatment-related quality of life in patients with type 2 diabetes mellitus. Diabetes Ther. 2019;10:119–34.CrossRef
35.
go back to reference Ishii H, Suzaki Y, Miyata Y, Matsui S. Randomized multicenter evaluation of quality of life and treatment satisfaction in type 2 diabetes patients receiving once-weekly trelagliptin versus a daily dipeptidyl peptidase-4 inhibitor. Diabetes Ther. 2019;10:1369–80.CrossRef Ishii H, Suzaki Y, Miyata Y, Matsui S. Randomized multicenter evaluation of quality of life and treatment satisfaction in type 2 diabetes patients receiving once-weekly trelagliptin versus a daily dipeptidyl peptidase-4 inhibitor. Diabetes Ther. 2019;10:1369–80.CrossRef
36.
go back to reference Goto H, Mita T, Fujitani Y, et al. Effects of linagliptin versus voglibose on treatment-related quality of life in patients with type 2 diabetes: sub-analysis of the L-STEP study. Endocr J. 2018;65:657–68.CrossRef Goto H, Mita T, Fujitani Y, et al. Effects of linagliptin versus voglibose on treatment-related quality of life in patients with type 2 diabetes: sub-analysis of the L-STEP study. Endocr J. 2018;65:657–68.CrossRef
Metadata
Title
Benefit of Early Add-on of Linagliptin to Insulin in Japanese Patients With Type 2 Diabetes Mellitus: Randomized-Controlled Open-Label Trial (TRUST2)
Authors
Tomoyuki Katsuno
Toshihiko Shiraiwa
Shingo Iwasaki
Hyohun Park
Nobuaki Watanabe
Shizuka Kaneko
Jungo Terasaki
Toshiaki Hanafusa
Akihisa Imagawa
Iichiro Shimomura
Hiroshi Ikegami
Hidenori Koyama
Mitsuyoshi Namba
Jun-ichiro Miyagawa
For the TRUST2 study group
Publication date
01-03-2021
Publisher
Springer Healthcare
Published in
Advances in Therapy / Issue 3/2021
Print ISSN: 0741-238X
Electronic ISSN: 1865-8652
DOI
https://doi.org/10.1007/s12325-021-01631-y

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